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CITY OF ORONO PERMIT NO.: 2004-07443 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 04/30/2004 <br /> j 952 249-4600 FAX: 952 249-4616 <br /> REPRINTED ON 10/14/2010 <br /> ADDRESS 270 NORTH SHORE DR W <br /> PIN 06-117-23-23-0019 <br /> LEGAL DESC IDYLLVALE FARM <br /> LOT 002 BLOCK 001 <br /> PERMIT TYPE SEPTIC <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE NEW <br /> NOTE: P07443-THIS PERMIT WAS APPLIED FOR AND KEYED INTO WRONG ADDRESS(270 NORTH SHORE DR W),DISCOVERED <br /> ON 9/23/10 BY PLANNING&ZONING. ASKED TO CHANGE TO CORRECT ADDRESS(210 NORTH SHORE DR W). <br /> APPLICANT PERMIT FEE SCHEDULE 100.00 <br /> OUVERSON EXCAVATING STATE SURCHARGE(VALUATION) 0.50 <br /> 252 36TH STREET S.W. <br /> MONTROSE,MN 55363 TOTAL 100.50 <br /> OWNER <br /> TASTAD,JOHN M&KIMBERLEY <br /> 210 NORTH SHORE DR W <br /> MOUND,MN 55364- <br /> AGREEMENT <br /> 5364AGREEMENT 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 f Q, <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 i �IyK•L <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. i <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 /> Applicant Permitee Signature Date Issued By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />