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CITY of ORONO _ <br /> BuildingPermit PERMIT NO. 6187 <br /> AND APPLICATION FOR CERTIFICATE OF OCCUPANCY DATE ISSUED /O -/s 6 <br /> P.O. BOX 66, CRYSTAL BAY, MN 55323 473-7357 <br /> ZON G plISTRICTR 35O �p <br /> � �A l�, <br /> SITE ADDRESS 6 ? <br /> IPROPERTY ID NTIFICATION NO.(PID) J 3-Ji - 41- c. 'dam 7 <br /> FIRE DEPARTr; LOT BLOCK I SUBDIVISION <br /> POST OFFICE t,t OWNER (Name) (Address) (Phone) <br /> VAR. DATE - Must Certify Multi-Family,Commercial& Industrial Construction Plans <br /> `_ <br /> (Firm) (Address) (Phone) <br /> COND. USE DATE <br /> LOT AREA BUILDER (Firm) (Address) (Phone) <br /> WIDTH a TH �C.1�T e n� . -63-09 26'm , 1' . j. 3/1 <br /> QS( 01 3' TYPE OF WORK <br /> WORKNew /2,Addition Remodel <br /> d <br /> el `Renovate <br /> PROPOSED SETBACKS: <br /> FR� �riuvR. SIDE,��t�� � J�- /L1� e / r�L cin/ <br /> CONST.TYPE BUILDING SIZE <br /> REAR L. SIDE Estimated Construction Valuation <br /> LAKE WETLANDS .112,,g_ L. ' c�% W. Ht. Vi i <br /> OCCUPANCY ERMIT FEES <br /> --• CLASSIFICATIONTb. s---6 • <br /> ACCESS DWELL. STORIES B 1 2 3 BLDG. PERMIT <br /> UNITS5 <br /> NEW XISTING ' STATE FEE t <br /> GAR. STALLS NUMBER OF BEDROOMS `� <br /> AGENCY-APPROV. DATE ATT. PLAN REVIEW 0 • -S <br /> CITY DET. SEPTIC <br /> APP. DATE SAC CHARGE <br /> COUNTY PROPOSED USE SEWER UNIT <br /> STATE PARK FEE <br /> PENALTY Fp' <br /> .SD <br /> PRIVATE EASEMENT COUNCIL <br /> APP. DATE OTHER <br /> TOTAL DUE ,H• j`�I <br /> REMARKS: (�7 <br /> 1 V?..3- <br /> WORK REQUIRING ACKNOWLEDGEMENT <br /> IPECTION <br /> REQUIREDSEPARATE PERMITS <br /> FOOTING before pour THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE <br /> FRAMING rough in PLUMBING I=1 THE REAL IMPROVEMENTS SPECIFIED. AND DECLARES <br /> INSULATION MECHANICAL ❑ UNDER PENALTY OF LAW ACKNOWLEDGEMENT AND ACCEPT- <br /> i'l WALLBOARD before taping <br /> WELL ❑ ANCE OF ALL INFORMATION. CONDITIONS AND REQUIRE- <br /> FINAL before occupancy <br /> SITE INSPECTION SEPTIC ❑ MENTS REPRESENTED ON THIS DOCUMENT. THE UNDER- <br /> WORK BEYOND OR WITHOUT A RESEWER ❑ SIGNED FURTHER AGREES TO DO ALL WORK IN STRICT COM- <br /> -QUIRED INSPECTION WILL BE SUB- WATER ❑ PLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE <br /> JECT TO PENALTY. OF MINNESOTA BUILDING CO E REQUIREME TS. <br /> GRADING&FILLING ❑ <br /> INSPECTIONS MUST BE CALLED-IN <br /> 24 HOURS IN ADVANCE. FIRE ❑ � <br /> Signature ' ��/ Date �� <br /> COPY:WHITE-FILE GREEN-FINANCE <br /> CANARY-INSPECTOR GOLD-RECEIPT / <br /> PINK-ASSESSOR Approve.' gib►i+ / . eiv.i /4_/ / City of Orono <br /> Brooklyn Prtg.&Adv.Co.Inc. 16121 561-4470 <br />