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� CITY OF ORONO PERMIT NO.: 2009-00642 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE iSSUEn: 09/28/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 4355 CHIPPEWA LA <br /> PIN : 31-118-23-42-0020 <br /> LEGAL DESC : N/A <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPT[C <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : REPAIR <br /> ��L�C�uJ <br /> rro�rE: <br /> REPAIR EXISTING PRECAST CONCRETE TANK <br /> APPLICANT SEPTIC REPAIR 100.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 <br /> 263 82ND STREET S.E. TOTAL 100.50 <br /> MONTROSE, MN 55303- <br /> (763)479-1762 PAID WITH CC# 4286 <br /> Minnesota State License#: 640 <br /> OWNER <br /> YOUNG,JOHN& LYNN <br /> 4355 CHIPPEWA LA <br /> MAPLE PLAIN, MN 55359- <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 a time or due cause. <br /> l2 j l � t..��`� �'� �lw l �/ � <br /> App icant Pe ' ee Signature Date Issue y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK O ER THAN DESCRIBED ABOVE. <br />