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,� CITY OF ORONO * 2 0 1 5 - 0 0 3 1 1 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 03/17/2015 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 480 STUBBS BAY RD N <br /> PIN : 32-118-23-13-0003 <br /> LEGAL DESC : LTNPLATTED 32 118 23 <br /> : LOT 000 BLOCK 000 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FUEL STORAGE TANK <br /> VALUATION : $ 1,600.00 <br /> NOTE: REMOVE UNDERGROUND FUEL OIL STORAGE TANK -300 GALLON <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.80 <br /> CDR EXCAVATING INC. TOTAL 50.80 <br /> 10559 CO. RD 16 Payment(s) <br /> DELANO,MN 55328- CHECK 7206 50.80 <br /> (952)955-3673 <br /> OWNER <br /> GAUSE, TODD& DONNA <br /> 480 STUBBS BAY RD N <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 specitied herein.This permit will <br /> expire and become null and void if construction authorized is no[ <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 inspec[ions are <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ���G�.� l LC J7 � /� �/.S <br /> Applicant Permitee Signature Date Issue y Signature Date <br />