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� � <br /> , O„�0�� City of Orono .•� -� � � <br /> n � ,� : <br /> / P.O.Box 66 5 <br /> � , 2750 Kelley Parkway '` q ���, x� <br /> � � � Crystal Bay,MN 55323 '�` � }% ` ��• '� ,� '� `y <br /> (952)249-4600 <br /> . , � <br /> CITY OF ORONO-USER DEFINED/GENERAL PERNIIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: 1135 Spring Hill Road,Wayzata, MN 55391 <br /> Owner: Robert W. Fullerton Mailing Address: 1135 Spring Hill Rd. <br /> C��,: Wayzata Zip: 55391 <br /> Home Phone: (952)473-2284 Alternate Phone: (952)229-8711 <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ❑ Stairwav to Lake ❑ Retainine Walls ❑ Temporarv Trailer <br /> General—User Defined Surchazge General—User Defined Surchazge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost:$ <br /> 0 Docks—42"or Greater ❑ Land Alteration ❑ Zonins Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$3(1.0(1 <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 /> 1 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 T understand this is not a permit and work is not to start without a permit; and that the <br /> work w' 1 be in accordance with the approved plan. <br /> ��` �=4���QQ� <br /> G✓. � <br /> Applicant , „4�0„�„ „n� � , .. Date <br />