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, � , <br /> CITY OF ORONO * 2 0 1 3 — 0 0 e 0 1 * <br /> • 2750 KELLEY PARKWAY DATE ISSUED: 08/15/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3210 GRAHAM HILL RD <br /> PIN : OS-117-23-11-0009 <br /> LEGAL DESC : GRAHAM HILL PRESERVE-2 <br /> : LOT 1 BLOCK 2 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTNITY : MOUND SYSTEM - SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> BURNS EXCAVATING, INC. STATE SURCHARGE SEPTIC 5.00 <br /> 3470 CO. RD 21 <br /> MAYER, MN 55360- TOTAL 205.00 <br /> (612)685-4303 <br /> Minnesota State License#: 1888 <br /> OWNER <br /> MESENBURG, MATT& MICHELLE <br /> 2525 KELLER ROAD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he work lor 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 goveming this type of work <br /> shall be compied with whether or not speeified 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.'1'his pennit may be <br /> revoked at any time for due cause. <br /> .�----- �` � l�' � �� � � <br /> Applica�t Permitee Signaturc Date Issued y � nature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBED AB E. <br />