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^ • Ci of Orono <br /> g,O j�\ tY FOR CITY USE ONLY <br /> O Q�, P.O.Box66 DateReceived: ��-5 u Permit# <br /> s�, }� 2750 Kelley Parkway � � <br /> H �N�' ���' ���� Crystal Bay,MN 55323 <br /> �� �ty'�J��j (952)249-4600 Amount: $� C.U.P Filed: <br /> �R�o$j <br /> Approved By:��Site Plan�C"��-s�V-S <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 Zoning Department) <br /> Job Site l Owner lnformation: � � <br /> z <br /> Site Address: l��T�� 7 n 5�'-1 d�k w,.�._ , P , <br /> Owner: � '1 �2,,J��C� MailingAddress: <br /> City: �JZ� �'1 v Zip: .5� �°� ) <br /> Home Phone: co I z C:�o g��, Alternate Phone: <br /> Contractor/Applicant Information: � <br /> � <br /> Contractor/App.: �r� �,��� �.-.v,,�n�.5�%�-�Contact Person: r� +�rc� �Y..-4-�. <br /> Address: ��5 3 �" '1�.c�( �-.�.r�- State License #: <br /> City: �}�1�� �w�� Zip: �7 3(,y Expiration Date: <br /> Phone: �-I ��. - � �� R Alternate Phone: t��2 �s� •.�3�y <br /> �� � '�� � TYPES OF USER DEFINED�PERMITS �� �� <br /> �Stairwav to Lake ❑ Retainin Walls ❑ Teinporary Trailer <br /> Generaf—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"or Greater ['�Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge Gen 1—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) �0-500 Cubic Yards *ForO-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 herby apply for a User Defined Permit and I acknowledge that the infarmation 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 /> wark will be_ir�- cc rdance with the approved plan. <br /> i u ,r <br /> - y• o ? <br /> Applicant .. Date <br /> °� �Reset Form <br /> (E7ser AeFina,d,Farti6t 3l18(04) <br /> . :+�„ ..�,.�::. . .... . .. <br />