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CITY OF ORONO PERMIT NO.: 2011-01243 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 10/18/2011 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 840 OLD CRYSTAL BAY RD S <br /> PIN : 09-117-23-12-0002 <br /> LEGAL DESC : UNPLATTED 09 117 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SEPTIC <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : NEW <br /> ACTIVITY : MOUND SYSTEM-SEPTIC <br /> NOTE: (3)PRECAST CONCRETE TANKS-EACH 1300 GALLON <br /> MOUND TREATMENT SYSTEM-45.5 X 87 S.F. TOTAL 630 SQUARE FFET <br /> APPLICANT SEPTIC NEW 200.00 <br /> KOTHRADE SEWER&WATER STATE SURCHARGE SEPTIC 5.00 <br /> 12059 WHITETAIL AVENUE <br /> HANOVER,MN 55341 MAIL-IN FEE 2.00 <br /> 0 TOTAL 207.00 <br /> Minnesota State License#: 0192 PAID WITH CC# 1239 <br /> OWNER <br /> WILLIAMS,JAMES&HEIDI <br /> 840 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 /> revoked at any time for a cause. <br /> Cl;ai%-ifAO/ /8 i 17 10/ / <br /> Applicant Permitee nature Date 731..4.4.f 0 i i <br /> Issueignature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />