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� �� <br /> CITY OF ORONO * 2 0 1 6 - 0 0 7 6 2 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 06/29/2016 <br /> ORONO,MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS : 517 FERNDALE RD N <br /> PIN : 36-118-23-14-0007 <br /> LEGAL DESC : LJNPLATTED 36 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : SPRINKLER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : BACKFLOW DEVICE ONLY <br /> NOTE: - NO SPRINKLER HEADS WITHIN 10 FEET OF SEPTIC DRAINFIELD. <br /> APPLICANT SPRINKLERS 50.00 <br /> STATE SURCHARGE FLAT-OTHER 1.00 <br /> RIGHTMARK LLC 1VIqIL-IN FEE 2.00 <br /> P.O.BOX 343 <br /> BUFFALO,MN 55313- TOTAL 53.00 <br /> (952)75&6237 Payment(s) <br /> CHECK 10223 53.00 <br /> OWNER <br /> ANDERSEN,STEVEN&STACIA <br /> 517 FERNDALE RD <br /> WAYZATA,MN 55391- <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 dces <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances goveming this type of work <br /> shall be compied with whether or not specified herein.'Chis 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> � <br /> ���� �P l �l /� <br /> Applicant Permitee Signatur Date Issued �ignature Date <br />