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CITYOFORONO * 2016 - 00377 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 04/25/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 4645 ST.ANDREWS ST <br /> PIN : 06-117-23-31-0011 <br /> LEGAL DESC : LAKEVIEW OF ORONO <br /> : LOT 14 BLOCK 3 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : SEPTIC(NEW OR REPLACEMENT) <br /> ACTIVITY : SEPTIC(MOLJND) <br /> NOTE: (3)PRECAST CONCRETE TANKS EACH 1300 GALLONS <br /> 630 SQUARE FOOT MOUND TREATMENT SYSTEM <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> HAYES&SONS EXC.INC. Payment(s) <br /> 263 82ND STREET S.E. CREDIT CARD 5293 400.00 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 <br /> Minnesota State License#:sept-L640 <br /> OWNER <br /> Source Land Development Inc. <br /> 18215 45TH AVE N <br /> STE D <br /> PLYMOUTH,MN 55446- <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 City approvals,and the <br /> State Building Code. 1'his permit is for only tt►e work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this typc 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 a8er work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. , <br /> - U ZS� !�� �� /�o <br /> � '-� i <br /> Applicant Permitee Signature Date Issued B ignature Date <br />