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CITY OF ORUNO * 2 0 1 0 - 0 0 7 4 8 * <br /> 2750 KELLEY PARKWAY DATE ISSUEU: 02/28/2012 <br /> � ORONO, MN 55356- <br /> ` 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 550 EAST LONG LAKE RD <br /> PIN : 35-118-23-14-0002 <br /> LEGAL DESC : UNPLATTED 35 1 18 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : ZONING PERMIT <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : LAND ALTERATION (501+CU YDS) <br /> NOTE: $AMOUNT TO BE DGTGRMINGD BY CUP-S/B COLLECTED IN ESCROW FF,F, <br /> ACTUAL GSCROW FEE AMOUNT COLLECTED $ Z�bO e � , <br /> t{OW D[D THGY PAY? Gk. Z,ZR�`j &WHO PAID? �U��/Ve��•d <br /> GSCROW PERMI"1�#:(DON'"I'FORGET TO ENTER) ZD1 p -Q 07 � 9 <br /> ESCROW FF,h;FOR: EROSION CONTROL&ENGINI:k?RING RI?VIEW COSTS <br /> APPLICANT MAJOR LAND ALTERATION 50.00 <br /> BOLLIG �, SONS, INC. ENGINEERING REVIEW COSTS <br /> 11401 COUNTY ROAD 3 <br /> HOPKINS, MN TOTAL 50.00 <br /> (612)938-4433 PAID WITH CASH 2O.00 <br /> OWNER <br /> NETJES, DAVID <br /> 550 EAST LONG LAKE RD <br /> WAYZATA, MN 55391- <br /> AGREEMEIYT AND SWORN STATEMENT <br /> I�he���ork for ti�hich this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State Buildine 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 eonstruction authorized is not <br /> commenced���ithin 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 days al any time atter work has commenced. <br /> The applica t is responsible for assuring all required inspections are <br /> requested in onformance with the State Building Code.This permit may be <br /> revoked at �time for due cause. <br /> -- -- / / <br /> pplicant Nermitec Signature Date Issued y Si r ture ' ate <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. <br />