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�0� City of Orono � FOR CITY S�Ep ONLY p <br /> O O P•O.Box 66 ������ '/ / � � 7�� <br /> Date Received: ermit# 1 <br /> ?y„ 2750 Kelley Parkway <br /> a �`�r � Crystal Bay,MN 55323 Amount $�� <br /> � ���- U.P Filed: <br /> �''?°�,,�'p��.yo` (952)249-4600 <br /> � o$ <br /> dBH Approved By: Site Plan: D•/r 6•ow <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 /> �ob:Site/Owner Information: <br /> Site Address: � ��f`� SVIU��(�'V�� �E � �'I� Sti�p��,� Lt���.���W�1/� <br /> Owner: Mailing Address: 3�G- � St�rz-t�r.e �f� <br /> City: �C�y-�c„�c� Zip; `�`�, �`'l 1 <br /> Home Phone: C �z— �I-�- 1 -' `�q-�J� Alternate Phone: <br /> �Contractor/Applicant Information: � <br /> � � <br /> Contractor/App.: �-' � ('t�L 4X%�� Contact Person: <br /> Address: �7�4 4�cx,�{x�d't � , State License #: <br /> City: ��v�,t✓1� Zip: �'3G�- ExpirationDate: <br /> Phone: � � Z — ��;�,"�--��U Alternate Phone: <br /> TYPES OF��iER DEFINED PERMITS <br /> ❑ Stairwav to Lake � Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Detined <br /> * (Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $SO 4•�� <br /> No PG4.1 lLev��T✓ FC2j�a <br /> ❑ Docks-One Time(tvon-r�ke mcka� ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Detined 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 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 wark is not to start without a permit;and that the work <br /> will be in accordance with the approved plan. <br /> �� 1�-��--�--�' 1 � .- I � - �`� <br /> Applicant Date <br /> tu�orno�s r�it osrpa�o�� <br />