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CITY OF ORONO <br />2750 KELLEY PARKWAY <br />ORONO, MN 55356- <br />1249-4600 FAX: (952) 249-4616 <br />ADDRESS <br />1020 WILLOW DR N <br />PIN <br />27-118-23-32-0022 <br />LEGAL DESC <br />SHADOWOOD FARM <br />LOT 000 BLOCK 000 <br />PERMIT TYPE <br />SEPTIC <br />PROPERTY TYPE <br />RESIDENTIAL <br />CONSTRUCTION TYPE <br />NEW <br />PERMIT NO.: 2008-00069 <br />DATE ISSUED: 07/23/2008 <br />APPLICANT <br />PATNODE BROS <br />23200 109TH AVE <br />ROGERS, MN 55374 <br />(763) 428-7393 <br />Minnesota State License #: 95 <br />OWNER <br />COX, JAMES & BERADINE <br />1020 WILLOW DR N <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 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 />Applicant Permitee Signature Date <br />a <br />SEPTIC NEW <br />STATE SURCHARGE SEPTIC <br />TOTAL <br />SEPARATE PERMITS REQUIRED FOR WORK <br />By Signature t / / <br />ER THAN DESCRIBED ABOVE. <br />100.00 <br />0.50 <br />100.50 <br />❑r <br />