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CITY OF ORONO PERMIT NO.: 2009-00832 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 11/20/2009 <br /> (952)249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 680 ORCHARD PARK RD <br /> PIN : 32-118-23-22-0006 <br /> LEGAL DESC : ORCHARD PARK <br /> : LOT 014 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> NOTE: INSTALLING: (3)PRECAST CONCRETE TANKS- 1000 GALLONS <br /> MOUND SYSTEM-550 SQUARE FEET <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES&SONS EXC. INC. STATE SURCHARGE SEPTIC 0.50 <br /> 263 82ND STREET S.E. TOTAL 200.50 <br /> MONTROSE,MN 55303- <br /> (763)479-1762 PAID WITH CC# 9999 <br /> Minnesota State License#: 640 <br /> OWNER <br /> WINTERS,DOUGLAS <br /> 680 ORCHARD PARK RD <br /> LONG LAKE,MN 55356 <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 /> vo e ...rtne for Ue cause. <br /> //—/ a/ <br /> pplicant ermitee Signature Date Issued :y ,:nature sate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB Se E. <br />