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O¢��O City of Orono ', -' FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: Permit# <br /> � 2750 Kelley Parkway <br /> � �' ,� � Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> : Y.; <br /> � gyo (952)249-4600 <br /> �O ApprovedBy: ' SitePlan: <br /> Recommends: A roval ❑ ' Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> t r <br /> � � � ,� <br /> � <br /> +� <br /> n �kJ�+� ��'�?s �s hr,.� � � ;� ,�,' ��t,��� <br /> Site Address: �`�� �"�4G/`'t G� <br /> Owner: `,PA'�- ���C�°r''v S K� Mailing Address: �j'7�!`ri� <br /> City: ��c�� Zip: 5�3 S� <br /> Home Phone: �'-1�2" g��—'�� Alternate Phone: 6�2 "- 3S2 ^ 3�2-/ <br /> �� �� � � �� ���� _ � <br /> �� ,� ����� ����� � ''a� <br /> ,�.� � „b ��. � � � <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> � $ � -� �� .� ��: <br /> e <br /> � <br /> �.s , ..:. �"..� ;.'. !u' <br /> � ,�*.^-' +� „.�,, � w� r <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surchazge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost:$ *Estimated Cost: $ <br /> �ocks-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> 1' General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> � Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Pernut and I aclmowledge that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code;that I understand this is not a permit and work is not to start without a pernrit;and that the work <br /> will be in accordance with the approved plan. <br /> . � �/Z�/��- <br /> App icant Date <br />