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CITY OF ORONO * Z 0 1 2 - 0 0 4 2 6 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/19/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 75 LEAF ST <br /> PIIV : OS-117-23-11-0014 <br /> LEGAL DESC : GRAHAM HILL PRESERVE 3 <br /> : LOT 1 BLOCK 3 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM- SEPTIC <br /> APPLICANT SEPTIC NEW 200.00 <br /> HAYES& SONS EXC. INC. STATE SURCHARGE SEPTIC 5.00 <br /> 263 82ND STREET S.E. TOTAL 205.00 <br /> MONTROSE, MN 55303- <br /> (763)479-1762 PAID WITH CC# 5293 <br /> Minnesota State License#: 640 <br /> OWNER <br /> KAPSNER,JASON&JULIE <br /> 760 DICKEY LAKE ROAD <br /> LONG LAKE, MN 55356- <br /> AGREEMENT AND SWORN STATEMENT <br /> Thc 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 additionai 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 specitied herein.This permit will <br /> expire and become null and void if construction authorized is no[ <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 /> re nforro�nce with t e State Building Code.This permit may be `j ' <br /> � <br /> �evoked �m or e ca e. � ' <br /> � � �-�C �- l � � l / i� �l - � <br /> �� — �� �. � � �r ,� � ... �� � <br /> Applicant Permi e ure Date Issued By Signature Date <br /> i <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />