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�0�^'' Ci of Orono <br /> �� tY FO 'CI Y USE ONLY n <br /> O 0� P.O.Box 66 Date Received: ,7 ' " Permit#�C� 1�' C <br /> + �, 1� 2750 Kelley Parkway <br /> `"� • ?C`� �1 f�f.'- �1 Crystal Bay,MN 55323 �, 4G <br /> ���\'��'�ryx�v f� (952)249-4600 Amount: $ � C.U.P Filed: � <br /> � "�O$� �-`y' /`!��G1c <br /> Approved By:�/� Site Pla�: <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 Zoni�g Department) <br /> Job Site/ Owner Information: <br /> Site Address: __ �`�J�`')J `����1�(iv] �C�l��l �(J�� � <br /> Owner: ��lik'r�� `l �.�G� t'I�l'��� Mailing Address: S 6{�� Ll� �l����, <br /> ��ty: �rv�� z�p: S�� 91 <br /> (������ I-- �'���( � �a ��5 -�-�� <br /> Home Phone: Alternate Phone: � � <br /> Contractor l Applicant Information: � ��� � <br /> Contractor/A f�t�� V v���� <br /> pp.: Contact Person: <br /> Address: �����,Cj,V` V��'�� State License #: � <br /> City: �1;��� 'U� Zip: � J�Yj Expiration Date: <br /> Phone: _`�l�`�" ���� � �U �Q�I <br /> "IX� Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS ' <br /> ❑ Stairwa_y to Lake ❑ Retainin Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks—42"ar Greater � Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) �0-500 Cubic Yards *ForO-7S 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 Permit and I acknowledge 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 permit; and that the <br /> work will be in accordance with the approved plan. <br /> �C � �� 7 '3 � � v �-l� <br /> ��- <br /> Applica ,� . Date � <br /> ��. Re t Forrn �, N ���«���z3�8�� <br /> .�, _ ���..a�•e,�� � <br />