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. <br /> o � <br /> TRANSMISSION VERIFICATION REPORT <br /> TIME : 07131/2�13 14: 41 <br /> NAME : ORONO <br /> F�X : 9522494616 <br /> TEL : 9522494615 <br /> SER. # : BROL2J412694 <br /> DATE,TIME 07I31 14: 41 <br /> FAX NO./NAME 6514316528 <br /> DURATION 0�: 0�: 00 <br /> PAGE(S) 0� <br /> RESULT EUSV <br /> MODE ST�NDARD <br /> EUSV: BUS`,'IhJU RESPONSE <br /> INTERAGENCY REQUEST FOR �UILQIN� IhISPECTfON <br /> � ��_ CHiLb CARE CENTERS <br /> Ta: r�� �$�p�� f Date: — <br /> d r <br /> � � /I.tJ7'�� <br /> From: , (Licensor) Phane Number: �D�� � ��� ! ���� <br /> I'rior ta issuing a license to provide child care, uerification is required that a facifity is in compfiance with <br /> apprapriate state, counky, and Focai building eodes (Minnesofia Rules, part 9503.0156, subpart 1), Please <br /> complete this fprm and re#urn it to the Deparkment qf Wuman Services, Div'tsion of Licensing with any orders <br /> �ttached. A copy of the arders should also be pro�ided to the progr�rrt. <br /> Narrle of prQgram: icense Number: �] <br /> Name of Facility: <br /> Address: ��� � �� �� �� <br /> Street City Zip Code <br /> Program Contact Pe�son: ��y �G��1C��'7 Phone Nu�nnber- �D�����"�L3� ���6 <br /> Areas.#o_be__used: Classrooms to be used; Number/Aqe Ran�ces of Chiidren� <br /> CI B�sement � �1 Entir� F�cility 6 weeks to 16 months� <br /> ❑ First Fiaor �/Specific raoms listed below, 16 mos. T� 33 manths� <br /> ❑ Second Floor �r~ 33 mas. To kindergarten: ��t <br /> —��,�_ <br /> p Other Kindergarten to 12 years: <br /> Specify: � �� ��� Totial:� <br /> 6uildin4 Inspection Results; �`D# ��,� ��Y1 <br /> �`r,��; <br /> ❑ Not Applic�ble: facility IoC�ted in non-coded area. <br /> D�te uf referendum �pte remo�ing �4�e requirements; <br /> Sign2ture and Title af Locaf Offfcial; � <br />