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CITY OF ORONO PERMIT NO.: 2009-00618 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 11/19/2009 <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 790 OLD CRYSTAL BAY RD S <br /> PIN : 04-117-23-43-0007 <br /> LEGAL DESC : AUDITOR'S SUBD.NO.229 <br /> : LOT 026 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> APPLICANT <br /> SEPTIC NEW 200.00 <br /> ES&SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 <br /> 263 82 <br /> 263 82ND STREET S.E. <br /> MONTROSE,MN 55303- MISC FEE 0.00 <br /> (763)479-1762 TOTAL 200.50 <br /> Minnesota State License#: 640 PAID WITH CC# 4286 <br /> OWNER <br /> BAKER,KAREN <br /> 790 OLD CRYSTAL BAY RD S <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 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 /> revok • at,y time for due cause. <br /> // b <br /> A.slicant P:07 ee Signature Date Issued By Sig ure ''9 t. <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV . • <br />