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� � ' CITY OF ORONO PERMIT NO.: 2011-00901 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 08/24/2011 <br /> ' 952 249-4600 FAX: 952 249-4616 <br /> ADDIcESS : 265 HOLLANDER RD <br /> PIN : 25-118-23-43-0016 <br /> LEGAL DESC : HOLLY ACRES <br /> : LOT 003 BLOCK 002 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> NOTE: (3)PRECAST CONCRETE 1000 GALLON TANKS� <br /> MOLTND-40 X 83 S.F. ROCKBED- 10 X 50 S.F. <br /> APPLICANT SEPTIC NEW 200.00 <br /> ELMER J.PETERSON COMPANY STATE SURCHARGE SEPTIC 5.00 <br /> 5921 DAGUE AVE SE <br /> DELANO,MN 55328 MISC FEE 0.00 <br /> TOTAL 205.00 <br /> OWNER <br /> DOEPKE,MARK&CONSTANCE . <br /> 265 HOLLANDER 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 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 sepazate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whekher 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 aze <br /> re uested in conformance with the State Building Code.This permit may be <br /> v ed at any tim�due cause. <br /> ���2F3��1 �� i ��o����l <br /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />