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CITY OF ORONO * Z 0 1 6 - 0 1 5 7 2 * <br /> ` 2750 KELLEY PARKWAY DATE ISSUED: OU04/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 3865 BAYSIDE RD <br /> P[N : OS-117-23-23-0008 <br /> LEGAL DESC : AUDITOR'S SUBD.NO. 203 <br /> : LOT 064 BLOCK 000 <br /> PERM[T TYPE : ZONING PERM[T <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : LAND ALTERATION(0-500 CU YDS) <br /> APPLICANT MINOR LAND ALTERATION 50.00 <br /> MISC FEE 50.00 <br /> DIANIS, DAVID TOTAL 100.00 <br /> 3865 BAYSIDE RD <br /> LONG LAKE, MN 55356- Payment(s) <br /> CHECK 4133 100.00 <br /> OWNER <br /> DIANIS, DAV[D <br /> 3865 BAYSIDE RD <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 cause. <br /> � <br /> c./' � �1V l l �L <br /> Applicant Permitee Signature Date Issue y i nature Date <br />