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CITY OF ORONO PERMIT NO.: 2011-00498 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 06/24/2011 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3380 GRAHAM HILL RD <br /> PIN : 05-117-23-11-0013 <br /> LEGAL DESC : GRAHAM HILL PRESERVE 2 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC y) <br /> (6\ — <br /> 5, <br /> t\ <br /> c7v ( - - <br /> APPLICANT SEPTIC NEW 200.00 <br /> PATNODE BROS STATE SURCHARGE SEPTIC 5.00 <br /> 23200 109TH AVE <br /> ROGERS,MN 55374 MISC FEE 0.00 <br /> (763)428-7393 TOTAL 205.00 <br /> Minnesota State License#: 95 <br /> OWNER <br /> RUDOW, DAVID <br /> 3380 GRAHAM HILL RD <br /> ORONO,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 City approvals,and the <br /> State Building Code. This permit is for only the 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 type of work <br /> shall be compied with whether or not specified herein.This permit will co <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 C) <br /> suspended for a period of 180 days at any time after 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 3 <br /> revoked at any time for due cause. _ <br /> / / <br /> Applicant Permitee Signature Date Issued By Siyature / .'ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER - AN DESCRIBED ABO 4.0 <br />