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May 15 08 10:54a Chris Roberts 952-440-6358 p.1 <br /> � � ���� City of Orono <br /> �'�'���� FO CI Y U5E ONLY <br /> i;�. ��` P.O.eos 66 ���b� <br /> ��� .- 2��0 Keiley Parkway �atz Rcceived:,T 8� Permit <br /> '�� �1��p. ��+ Crystal Bay,MN 55323 <br /> `+ ��r•��y� (952)249-4600 <br /> `��+sao�� Amounc $ C,U.P Filcd: <br /> ` Approved IIy: p(.�. S(te�'lan: <br /> Recommends: A rov8] _T)C_T!'.8I � <br /> CITY OF ORONO - USER DEFINED/GENERA�L PERMIT <br /> (Al I perm its must be approved by the Quilding Official and/or Loning Dzpartment) <br /> Job Site/Owner Information: <br /> � � <br /> Site Address: �/ ll��� ,�'�1 � <br /> � �(� ._ <br /> O»ner: �T� L y � � Vlailing Address: <br /> City: ���r� Zip: <br /> Home Phone: Alternafe Phone: <br /> Contractor/Applicant information: <br /> Contractor/App��'�`�4 �`��ontact Person: ���'� <br /> Address: ���� �/�ef ���� '�tate License #: <br /> City: �� � Zip; ����xpiration Date: <br /> Phone: �f������ Altemate Phone: ���—����'�j.'��,� <br /> TYPES OF USER DEFINED PERMITS <br /> Staitr��av to Lake Retainin V�'alls <br /> � .� ❑ Temporary Trailer <br /> eneral—U�r Delined Surchargz ,,�y. General—Uscr Defir.ed Surcharge General—User Dzfincd <br /> � (Per ZJBC) ���'(,,�`�, JC� * (Per�JBC) *$30.00 <br /> "Estimated Cost: !� *Estimated Cost:$ <br /> ❑ Docks—42"or Greater ❑ Land AEteration ❑ Zonin�Review <br /> General—User Defincd Surchazgc Genetal—User�efined General—User D�fined <br /> ❑ Cornmerciai—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.40 <br /> '� Estimated Cost: $ $50.00(Needs Sita Planj <br /> Gencral—User Defincd ❑ SD]f Cubic Yards <br /> ❑ Residential- �30.60 �50.00(NeedsC.U.P.) <br /> ❑ Tree Removal <br /> Ceneral—User Dcfined <br /> * W'iihin 0-75'-$30.00 <br /> ] herby apply for a User Defined Perm�t and I ackno�vledge that the information above is complete and <br /> accurate;that the work will be in conformance with tlte Ordinances and Codes of the City and w-ith the State <br /> Bu'ldi Code; that I understand this is not a pennit and work is not ta start without a permit; and that the <br /> w r ��3 be in a o ce�v' the approved plan. <br /> � . <br /> Appl i cant ate <br /> Tlac•e4 C�+�rr.. - - - <br />