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CITY OF ORONO * 2012 - 01204 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 1 V28/2012 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS 2643 THOROUGHBRED LA <br /> PIN 04-117-23-12-0021 <br /> LEGAL DESC OLD CRYSTAL BAY ROAD 2ND ADDN <br /> LOT 006 BLOCK 002 <br /> PERMIT TYPE ESCROW FEE-WETLAND <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE ESCROW FEE-WETLAND <br /> NOTE: WETLAND BUFFER ESTABLISHMENT ESCROW PERMIT 2012-01042 <br /> APPLICANT ESCROW FEE-WETLAND 1,000.00 <br /> CHAMPLIN,JUDSON&ALEYA TOTAL 1,000.00 <br /> 2643 THROUGHBRED LA <br /> LONG LAKE,MN 55356- <br /> OWNER <br /> CHAMPLIN,JUDSON&ALEYA <br /> 2643 THROUGHBRED LA <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 /> revoked at any time for."due,' use. J <br /> App cant Permitee Signature Date <br /> issued By gnature to <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABPYE. <br />