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CITY OF ORONO <br /> * 2 0 1 4 — 0 1 2 4 3 <br /> 2750 KELLEY PARKWAY DATE ISSUED: 10/28/2014 <br /> ORONO,MN 55356- <br /> 952 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 1000 WILLOW DR S <br /> PIN 10-117-23-21-0004 <br /> LEGAL DESC UNPLATTED 10 117 23 I <br /> : LOT 000 BLOCK 000 V U <br /> PERMIT TYPE SEPTIC � d fvh; - <br /> PROPERTY TYPE RESIDENTIAL V� <br /> CONSTRUCTION TYPE NEW �(� ,,�( ' <br /> ACTIVITY MOUND SYSTEM-SEPTIC v- �etm14 � �✓�� -w�yoTt-� <br /> APPLICANT SEPTIC NEW 200.00 <br /> SWEDLUND SEPTIC STATE SURCHARGE SEPTIC 5.00 <br /> TOTAL 205.00 <br /> 930 DEER CREEK PARKWAY <br /> MPayment(s) <br /> N 56011- <br /> 952-657-1034 CHECK 5072 205.00 <br /> OWNER <br /> KLOMBIES,LINDSAY&ANNA <br /> 1000 WILLOW DR S <br /> WAYZATA,MN 55391 <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 /> revoked at any time for due cause. <br /> i (/ice D 2 <br /> Applicant Permitee Signature Date Issued Signature Date <br />