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�, PERMIT <br /> �.ITY OF ORONO <br /> � 2750 Kelley Parkway- PO Box 66 Permit Number: Poso2i <br /> C .rystal Bay, Minnesota 55323 Permit Type: Septic <br /> (9�2} 249-4600 Date Issued: loiii2ooa <br /> SITE ADDRESS: 3640 Jacobs Mill Rd <br /> I.ong Lake,MN 55356 <br /> P I D: 3 2-118-23-24-0010 <br /> DESCRIPTION: <br /> Proposed Use: Residenrial <br /> Perxnit Class: General <br /> Pernut Type: Septic Pernut Sub-type(s): New Sepric System <br /> DETAILS: <br /> Approved per resolution#: <br /> Separate pemuts required: <br /> NOTICES/REMARKS: <br /> FEE SUMMARY: Permit Fee: $ 100.00 Valuation: $ 0.00 <br /> State Surcharge Fee: $ 0.50 <br /> TOTAL FEE: $ 100.50 <br /> APPLICANT: RC Grading&Excavating,�nc. OWNER: Matt Vanslooten <br /> P.O.Box 24 3640 Jacobs Mill Rd <br /> Albertville,MN 55301 Long Lake,MN 55356 <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED <br /> AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF <br /> MINNESOTA BUILDING CODE REQUIREMENTS. <br /> , - /r(. <br /> LICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE � <br /> Conies: 1-File(Siunitures Repuired),1-At�nlicant, 1-Monthlv Revorts, 1-Assessin�, 1-Finance Page 1 <br />