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//���\\ City of Orono F R C[TY�UtSE ONLY <br /> /� � P.O.Box 66 �-w permit#��'T 1 <br /> (Q Q',.; Date Received: <br /> �� �s. � 2750 Kelley Pazkway �,/ <br /> ',� •�1�'�. �� Crystal Bay,MN 55323 .7�� <br /> ������� (952)249-4600 Amount: $� � •��� C.U.P Filed:������ ��/��� <br /> �:_, /� <br /> Approved By:���site Plan:b•3�•O S <br /> Recommends: Approval Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building O�cial and/or Zoning DepaRment) <br /> Job Site/Owner Information: <br /> Site Address: l'��.dC� -�'j' p��e� ��CxGe.. � 0 �''o n o � �`� (� �� �j� <br /> Owner: �inL1.- W���vY1Ge.�/1 Mailing Address: ID Z. � � ��Se�r. <br /> city: C� ro�to zip: 11�e3�.�.1 zt��-u.; M�5� ��( I <br /> T J <br /> Home Phone: �L5 2.- �-�I-I 5 - O Z� � Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractar/App.: �-�a l� {-,i �1,eY,�V1G . Contact Person: I t (� (��,C�� � <br /> Address: 3`�(05 �� �d �O State License#: <br /> City: d►�G�'�U Zip: 553�� Expiration Date: <br /> Phone: ��JZ��'y(p"Z�Z2 Alternate Phone: � 1'�- gOZ.- (��� <br /> TYPES OF USER DEFINED PERMITS <br /> �, Stairway to Lake - In(,line� ❑ Retaining Walls ❑ Temporary Trailer <br /> General-User Detined Surcharge t�B�r General-User Detined Surchazge General-User Detined <br /> *(Per UBC) sr'a f o��z1�r*(Per UBC) *$30.OQ <br /> *Estimated Cost:$�O,Q�.c�,''US� *Estimated Cost:$ <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-llser Detined Sureharge General-User Deflned General-User Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost:$ $SO.00(Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $SO.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Wlt�]Iri�-�5' -$3�.�{) <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 <br /> work will be in cor ance w� he ap roved plan. <br /> ✓� <br /> fo f?1�D� <br /> Applicaut Date <br /> R et Form NmxThhfincdPmnit3/ISl04) <br />