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. <br /> .¢�� City of Orono FOR CITY USE ONLY ,�1 <br /> O O P.O.Box 66 Date Received: � /� Permit# I�*�_ �5�� <br /> a �� 2750 Kelley Parkway <br /> i 'r � Crystal Bay,MN 55323 Amount: S ..�.��. �� C.U.P Filed: <br /> ��'��f���'�,� (952)249-4600 <br /> �o� <br /> Approved By:� Site Plan: <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 /> xrt. �. , ..�: r ^� ak."�Y'- <br /> Job`Sife/�Owner"Infozinatso"�- <br /> Site Address: _45� 5t'��IJ�" ��� �I� <br /> �,�,.�+� S��,.,� ►-�,�.. �L+n <br /> Owner: � ` �J"`'�� Mailing Address: y� � . <br /> �� �r�. <br /> City: C�I�NC7 Zip: � 5 3 �� <br /> Home Phone: �'�~ � Z"�' —3� �r Alternate Phone: G�''—3� � - �"�� � <br /> Contractor L;Applicant Information: <br /> Contractor/App.: ��V�v��' D�SIC� Contact Person: ���� ��� <br /> Address: ��g �� �� ��� State License#: <br /> City: (N�� �'� zip: 550�� Expiration Date: <br /> Phone: �5�� 'T`✓5� �� X 21 Alternate Phone: `� G'�'� ��''3�'aZ- <br /> .='f'm��f�.,'�:.�.. X�'�3�`.'��.T,�t}���.A�:�c �� ��' y �.,�E�.>.. �.�� � ����u,`J�'�� ��� i dY ��� � `f�"tly�i��'�� E�, <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> Genenl-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 ❑ Zoning Review <br /> General-User Defined Surcharge E � er�eral-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 C�� ���0. <br /> General-User Defined r � � p �, <br /> *Within 0-75' -$30.00 `.� 1 � -� ��11 L-�. <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 pernut;and that the work <br /> will be yn aecord �th the approved plan. <br /> J ��� � �� � <br /> �� <br /> Applicant Date <br /> '�i"'sc'�rier��i�iiai�� <br />