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� PERMIT <br /> CITY OF ORONO <br /> 2750 Kelley Parkway- PO Box 66 Permit Number: po9268 <br /> Crystal Bay, Minnesota 55323 Permit Type: Vacuum Breaken <br /> (952) 249-4600 � Date Issued: <br /> I 10/6/2005 <br /> SITE ADDRESS: i 3085 Jamestown Rd Unit# <br /> ' Long Lake,MN 55356 , <br /> P��� 28-118-23-33-0010 � <br /> DESCRIPTION: <br /> Proposed Use: Residenrial <br /> I <br /> Permit Class: P!lumbing <br /> Permit Type: <br /> Vacuum Breaker Pernut Sub-type(s): Vacuum Breaker <br /> i <br /> DETAI LS: , <br /> Approved per resolution#: <br /> Separate pemuts required: <br /> I <br /> NOTICES/REMARKS: <br /> � <br /> � <br /> FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 400:00 <br /> State Surcharge Fee: $ 0.50 <br /> Misc.Fee: $ 1.50 I <br /> TOTAL FEE: $ 37.00 <br /> APPLICANT: Weld&Sons Plumbing Company,Inc. OWNER: Mr.&Mrs. Gary Larson ' <br /> 315 Juneau La 3085 Jamestown Rd <br /> Plymouth,MN 55447 Long Lake MN 55356 <br /> THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED <br /> AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND S'�ATE OF <br /> MINNESOTA BUILDING CODE REQUIREMENTS. <br /> � <br /> i�G'��C�r' �!t G'�`�`i�� <br /> APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE <br /> Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) I Page 1 <br /> � <br />