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CITY OF ORONO PERMIT NO.: 2009-00720 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 10/19/2009 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 4701 WEST BRANCH RD <br /> PIN : 07-117-23-22-0016 <br /> LEGAL DESC : WEST BRANCH ACRES <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: <br /> PRECAST CONCRETE-(3)TANKS-SIZE OF TANKS-1250 <br /> MOUND SYSTEM- 10 X 63 SQ.FT. <br /> APPLICANT SEPTIC NEW 200.00 <br /> PRIDE CONSTRUCTION&EXCAVATING STATE SURCHARGE SEPTIC 0.50 <br /> 9450 WEST HILL ROAD <br /> WATERTOWN,MN 55388 MISC FEE 0.00 <br /> (952)475-2928 TOTAL 200.50 <br /> OWNER <br /> ALBERTSON,DAVID&WENDI <br /> 4701 WEST BRANCH RD <br /> MOUND,MN 55364- <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 <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 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 <br /> revo e at any time fo <br /> ,eer.", //7 0 9' API"' / 70, /Oji D lc <br /> Applicant Permitee Signature Date Iss,r(By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />