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CITY OF ORONO * 2015 - 00906 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 07/23/2015 <br /> ORONO, MN 55356- <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRE95 1180 TOWNLINE RD <br /> PIN 30-118-23-32-0001 <br /> LEGAL DESC UNPLATTED 30 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE NEW OR REPLACEMENT(SEPTIC SYSTEM) <br /> ACTIVITY MOUND SYSTEM-SEPTIC <br /> NOTE: (3)PRECAST CONCRETE TANKS(1) 1300 GALLON AND(2)1000 GALLON <br /> MOUND TREATMENT SYSTEM-500 S.F. <br /> APPLICANT SEPTIC NEW OR REPLACEMENT 400.00 <br /> TOTAL 400.00 <br /> ELMER J.PETERSON COMPANY Payment(s) <br /> 5921 DAGUE AVE SE CHECK 19497 400.00 <br /> DELANO,MN 55328 <br /> (763)972-2420 <br /> Minnesota State License#: BUIL-219 <br /> OWNER <br /> THEIS,MR&MRS MICHEAL <br /> 1180 TOWNLINE RD <br /> MAPLE PLAIN,MN 55359- <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 /> revoked at any time for due cause. <br /> LW4--4'9 4 1-) o 7i,73 i5 <br /> Applicant Permitee Signature Date Issue Signature U Date <br />