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• �,¢p� City of Orono � �I r���,y <br /> � � P.O.Box 66 n Date Received: • P�rit#��f"�"� oZ! <br /> 2750 Kelley Parkway I1 ,�� ����„�� <br /> ' � , � Crystal Bay,MN 55323 I /1� '(�q Arnotunt: ' S C.U.P�riled: <br /> (952)249-4600 ��`� � �l V <br /> �� �� <br /> A��v�a s�:����� s��r�; <br /> x�nmer,as: A neuat p ` <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: Z�l�S TLi��n/��1��� �1� ���"''�, �y�L <br /> Owner: JS'7- Q/-•0,,.4/_�LL Mailing Address: � ,�o� /Z�_ <br /> �,���5 <br /> City: ,l✓�w�-rc� /1'�� Zip: �?� <br /> Home Phone: Alternate Phone: /�'SZ-�/7/- �//� <br /> Contractor/App.: S�r�-��-�e./L �f��ontact Person: rir�/�� <br /> ��_ <br /> Address: �30 I Z��f� �l State License#: BG ZD'(o Z 7�9L� <br /> �T <br /> City: �7`�d`'"��'� �Zip: S�y�G' Expiration Date: Za/v <br /> Phone: _T Z- Z/ Z —�/R"j Alternate Phone: ISZ- Z.�z --v/g9 <br /> ❑ Stairwav to Lake �Retainin Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surchazge General—User Defined <br /> *(Per UBC) *(Per UBC) ao *$30.00 <br /> *Estimated Cost: $ *Estimated Cost:$ .Sc� <br /> ❑ Docks-One Time(rton-rake Mc�� ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surchazge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost:$ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- $30.00 $50.00(rreeds 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 aclrnowledge 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 pernut;and that the work <br /> will be in accordance with the approved plan. <br /> /,.�-/V 2 z�9' <br /> ican Date � <br />