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, � CITY OF ORONO PERMIT NO.: 2010-00139 <br /> � � 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- �ATE [ssuEn: 03/29/2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 2650 COUNTRYSIDE DR W <br /> PIN : 04-117-23-12-0014 <br /> LEGAL DESC : OLD CRYSTAL BAY ROAD ADDN <br /> : LOT 006 BLOCK 002 <br /> PERMIT TYPE : USER DEFINED <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : LAND ALTERATION (0-500 CU YDS) <br /> ACTIVITY : O/S GENERAL <br /> NO"I'E: OTHER INSPECTION: AF"I�F,R SILT PENCE IS INPLACE AND CORNERS OF SPORT COURT,SIDf?AND I2GAR YROPER"fY <br /> LINES ARE MARKGD. <br /> ANY I�GNCE AROUND SPORT COUR�I'CANNOT I31?OVER 6'HIG►1 '� <br /> APPLICANT LAND ALTERATION 50.00 <br /> JORGENSON, ROBERT TOTAL 50.00 <br /> 2650 COUNTRYSIDE DR W <br /> LONG LAKE, MN 55356 <br /> OWNER <br /> JORGENSON, ROBERT <br /> 2650 COUNTRYSIDE DR W <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 specitications,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 rclated 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 not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of l80 days at any time aRer 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 /> revo d at any time for due cause. <br /> j` u �v���r � � � � <br /> A plicant Perm e Si ature Date Issued By Signaturc Date <br /> SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />