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0,���0 City of Orm�o FOR CITY USE ON[,Y �/t <br /> P.O.Box66 DateReceived: Permit� cQB�7 " �7�� <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 <br /> ��^� (952)249-4600 Amount: S ��� C.U.P Filed: <br /> Approved By: �6'f'T•K Site Plan: <br /> Recommends: A roval D�nial ❑ <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Buitding Oflicial and/or"Loning Departnaent) <br /> Jobf����!CJ�vyrter.�l��oxm����. F=.. ::� M nn ; <br /> Site Address: ��g S �Ta� �� 55� <br /> Owner: .3k'•v,c.-s far,�. �s�,�,�� Mailing Address: ���Jd )'Ce��,'� ,� L..��7� N�� <br /> City: ��N�o�- � � Zip: 5`�`�`//- /�2��' <br /> Home Phone: ��3 --G��- �oc� 3 A[ternate Phone: 7� '3= j S�- � D�U <br /> �ou�xaCt4�;!A li�.it�,tt���`i�a��n. . .::. : �; <br /> �P <br /> Contractor/App.: ( ,� .� C.v. Contact Person: L.�.���� ���, �c/ <br /> ___----- <br /> Address: %`��p� �/e.. � �/�<c State License#: <br /> � �...----" <br /> City: f����.� Zip: J�37�/ Expiration Date: <br /> Phone: ��G I- ���'6�3� Alternate Phone: //�� �iv��/�`� <br /> ....., __� <br /> _�` ' �'::•'?.. .. ..::, i .r .',,:,�'�k'i�.�R;��. :b�.`k". � �?�!�`+ � � ; ' _;1 . .�.f.. 4 , _:�:.-"'.�.:..,�H�:; <br /> ❑ Stairwav to Lake ❑ Retainine Walls ❑ Temporarv Trailer <br /> General—User Fkfined Surcharge General—User Delined Surcharge General—Uscr Defincd <br /> "'(Per UBC) *(Per UBC} *$30.00 <br /> *Estimated Cost; $ *Estimated Cost:$ <br /> ❑ Docks-One Time(Non-�ake M�ka) � Land Alteration ❑ Zonin2 Review <br /> General—User Dcfined Surcharge ral—User Dcfined General—User Detined <br /> ❑ Commercial-(Per UBC) �0-500 Cubic Yards �0 • •Por0.75'Zone-$30.00 <br /> *Estimated Cost:$ $50.00(Needs Site Pian) <br /> General—User Ikfined . S <br /> ❑ Residential- $30,OQ . s .u.E�.� <br /> � Tree Removaf <br /> Gencrel—User Defined <br /> * Within 0-75'-$30.00 <br /> [ 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 1 understand this is not a permit and work is not to start without a permit;and that the <br /> work will be in accordance with the approved plan. <br /> �.,.i'� --..� �i-' <br /> �.. l� .- /� — p�3 <br /> Applicant � -� 4 -;, _ - , Date <br /> ,�@8����`?�� ::: ,; nMacR�suwr�4�?s1 <br /> t ......1 ...:T: . ... . . <br />