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_ ,��� City of Orono F R C T ONLY /�,,������ <br /> � O; O P.O.Box 66 Date Received: -�ermit# tl(J�(L� <br /> �;;.�`,, 2750 Kelley Parkway <br /> � �i'�!��.i'> ,� Crystal Bay,MN 55323 Amount: $ ���`�.U.P Filed: <br /> �' '��;���Y��y�` (952)249-4600 <br /> ���oa <br /> Approved By:�/�,�� Site Plan: y'L 9 -f�S <br /> Recommends: A roval [} Denial ❑ <br /> �� �1.,�,,.e�, <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pemiits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/�Owner��Information: <br /> Site Address: I� S`� Shfl r e 1;n� s , <br /> Owner: �Q� ��;,�k�r�, Mailing Address: ��A- <br /> City: C7j�w� Zip: S s 39 � <br /> Home Phone: � � Z b�a o z�� Alternate Phone: <br /> Contractor/Applicant Infonnation: <br /> Contractor/A C� �,�o ' <br /> pp.: � 1-,arn��ck�:�-� Contact Person: �ra'1 �yy� , <br /> Address: 3 i,5 3 {,n�r� �.a.,.� State License#: <br /> City: Yn o wr� Zip: �S�`� Expiration Date: <br /> Phone: �i S � - �i � a - �I 1 1� Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> � Stairwav to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> * (Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost: $ IoODo, o� *Estimated Cost• $ <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General-User Defined Surcharge 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 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Within 0-75' -$30.00 <br /> I herUy 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 perniit;and that the work <br /> will be in nce with t e approved plan. <br /> �► - a`j- o� <br /> Applicant Date <br /> (User De6ned Pernrit 3/18/Q4� <br />