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� CITY OF ORONO PERMIT NO.: 2oiaoosos <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 10/1U2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2055 SALEM CT <br /> PIN : 27-118-23-34-0008 <br /> LEGAL DESC : DICKEY LAKE ADDN <br /> : LOT 006 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURNS EXCAVATING,INC. <br /> 3470 CO.RD 21 STATE SURCHARGE SEPTIC 5.00 <br /> MAYER,MN 55360- MISC FEE 0.00 <br /> Q TOTAL 205.00 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> SODERSTROM ET AL,JEFFREY E <br /> 2055 SALEM CT <br /> LONG LAKE,MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable Ciry approvals,and the <br /> State Building Code. This permit is for only the work described and dces <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of 180 days at any time aRer work has commenced. <br /> The applicant is responsible for assuring all required inspections aze <br /> requested i onformance with the State Building Code.This permit may be <br /> revoked time for du c se. <br /> � f_ U� i / /l>l // l /d <br /> plicant e ite gnature Date Issu y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />