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O¢��,0 City of Orono FO CI U ONLY <br /> P.O.Box 66 Date Receive,� . Permit# � � <br /> � 2750 Kelley Parkway <br /> �� ,� Crystal Bay,MN 55323 /q Amount: $_� C U.P Filed: <br /> ♦ � +���y� (952)249-4600 /�-►� <br /> 2��t/ V APProved By: � Srte P�an: Q� <br /> ` an <br /> �� <br /> Recommends: A rova] �' Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (Ali permiu must be approved by the Building Official and/or Zoning Department) <br /> . q � <br /> i ` <br /> '��� Nrku.�fi` n� . <br /> Site Address: ���� C(J�rl � V� IV ��n�, �� ��� <br /> Owner: O a M U I u��n Mailing Address: SQ I'�e dS Q p�V e <br /> ���: 0 rono Z�p: 5�3�Co <br /> Home Phone: N �� � u l0� 4(O I� Alternate Phone: <br /> � � ����. ,m�,��� ��{�, <br /> Contractor/App.: non� Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> �� . , � <br /> r�:,.,.� M�� <br /> � <br /> ❑ Stairwav to Lake ❑ Retainin Walls ❑ Temnorarv Trailer <br /> General—User Defined Surchazge General—User Defined Surcharge Genenl—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> Docks—42"or Greater Land Alteration <br /> ❑ ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined Genenl—User Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> Genenl—User Defined ❑ 501+Cubic Yards <br /> �Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User De£ned <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Permit and I aclrnowledge 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 permit;and that the work <br /> will be in accordance wi ppro d plan. <br /> / � 4�' __ . �r�� 19�, ��08 <br /> Applicant Date <br />