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r � <br /> ,��� City of Orono FOR CITY USE ONLY <br /> P.O.Bo�6G Date Received: Permit# <br /> ��;,.;. � 275o Kelley Parl.way <br /> �, h�)'��.��,r- � Crys[al Bay,MN 55�2_ Amount: $ C.U.P Filed: <br /> �''�;.yg'�jh��y�� (952)2�19-4G00 <br /> �sssae• <br /> Approved By: Site Plan: '1'26 ��� <br /> Recommends: A rov Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERA.L PERII�IT <br /> (All ponnits must be appro��ed by the Building Official and/or Zonine Departmen[) <br /> 7ob Site/O�t�:ier I�lforniation: <br /> Site Address: <br /> Owiler: l'�D�"ZQ_,1�r(V1� Mailin;Address: �3C� 1����,v <br /> City: Zip: �j3FJ(D <br /> Home Phone: ��Jc�— �7(a— �� '�(� Alteniate Phone: C�(a—50�—��d� <br /> Conh-actor/Applicant Itlfornlation: <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Eapiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERNIITS <br /> ❑ Stairwav to Lalce ❑ Retainin�Walls ❑ Temuorarv Trailer <br /> General—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 ❑ Zonine Review <br /> General-User Detined Surchar_e Gener Us�r Detined General-User Detined <br /> ❑ Coiiunercial-(Per UBC) �-0-�00 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ SSO.00(Needs Site Plan) <br /> Ceneral—User Detined ❑ 501+Cub1c Yards <br /> ❑ Residential- �30.00 �50.00(Needs C.U.t�.) <br /> ❑ Tree Removal � <br /> General—User Defined <br /> *Within 0-75' - $30.00 <br /> I herUy apply for a User Defined Pennit and I aclmowledge that the information above is complete and <br /> accurate; that the �vork«�ill 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�vork <br /> will be in accordance with the approved plan. <br />