2005-P08696 - land alteration - Laserfiche WebLink

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g�� City of Orono FOR CITY USE ONLY q O � P.O.Box 66 Date Received: � 9� Permit# ��(v ((P , .�, 0 2750 Kelley Parkway , a �1� �'�j?- � C stal Ba ,MN 55323 �� ��'�� - F rY Y Amount: $ 50, C.U.P Filed: �#�hog�,�` (952)249-4600 Approved By: � tte Plan: Recommends: A roval ❑ Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT (All pe�mits must be approved by the Building Official and/or Zoning DepaRment) Job Site/Owner Information: Site Address: ;+� ��`� J��,.�� h . Owner: `�� ,��; �<� �� Mailing Address: ��ti,� �" City: �11,0,��.o Zip: SS 3� ) Home Phone: Alternate Phone: Contractor/ Applicant I�iforniation: Contractor/App.: C� �� scc�-�•�Contact Person: N v,-r� �J_�n .-�1-� Address: 3�S 3 �j�v.a� �-�.-�....— State License #: City: �o�- Zip: �5��`f Expiration Date: Phone: 9� Z y��z � � ti � Alternate Phone: TYPES OF USER DEFINED PERMITS ❑ Stairwav to Lake ❑ Retainin Walls ❑ Temporarv Trailer General-User Defined Surcharge General-User Defined Surcharge Genera]-User Defined * (Per UBC) *(Per UBC) * $30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks-42"or Greater �and Alteration ❑ Zonin Review General-User Defined Surcharge Gener User Defined General-User Defined ❑ Commercial-(Per UBC) 0-500 Cubic Yards *Far0-7S Zone-$30.00 *Estimated Cost: $ $50.00 (Needs Site Plan) General-User Defined ❑ 501+CubiC YaTds ❑ Residential- $30.00 $SO.00 (Needs C.U.P.) ❑ Tree Removal � '-1 -}- General-User Defined ��2.,P�� w� � �1 *Within 0-75' - $30.00 � I herby apply for a User Defined Permit and I aclrnowledge that the information above is complete and accurate; that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be in, ordance ith the appr ve an., i � � /� J o �' Applicant Date (User De6ned Perarit 3l18lQ4)