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• ' � <br /> CITY OF ORONO PERMIT NO.: 2009-00641 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 09/28/2009 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2250 FRENCH LAKE RD <br /> PIN : 10-117-23-22-0012 <br /> LEGAL DESC : JOHNSTONS FRENCH LAKE 2ND ADDN <br /> : LOT 001 BLOCK 002 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW -- h'lOGC/) 'G� <br /> NO'I'E: <br /> TANKS-(3)PRECAST CONCRETE(2)EXISTING AND(1)NEW <br /> APPLICANT SEPT[C NEW 200.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 <br /> 263 82ND STREET S.E. <br /> MONTROSE, MN 5530� TOTAL 200.50 <br /> (763)479-1762 PA[D W[TH CC# 4286 <br /> Minnesota State License#: 640 <br /> OWNER <br /> COSGROVE, DODD&ANN <br /> 2250 FRENCH LAKE RD <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 approvcd plans and specitica[ions,applicablc City approvals,and the <br /> State Building Code. This permit is for only the work described and does <br /> not gran[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 wi[h 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 y time or ue cause. <br /> /,��' / �r <br /> A plicant ermi ee Signature Date � ����� <br /> Iss d By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK THER THAN DESCRIBED ABOVE. <br />