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♦ <br /> ,���, City of Orono F y�I,.T�U�E ONLY /� <br /> O Q P•O.Box 66 Date Received: ���'G//['J% Perrtiit#;���/� <br /> 'at�,„ 2750 Kelley Parkway , T �� <br /> � �"�i�:� h Crystal Ba ,MN 55323 <br /> 6 � �,� ¢ Y <br /> �'���,ov�,� (952)249-4600 .4mount: $ C.U.P Filed: <br /> Approved By:p�_�(J�G�Site Plan: <br /> 1 <br /> Recommends: A roval Denial <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All pennits must be approved by the Building Official and/or Zoning Department) <br /> 7ob Site/Owner Information <br /> Site Address: J C�d-� <br /> Owner: ,�1�UGHi �4l �/J�_ Mailing Address: <br /> City: � r���� Zip: S� <br /> � � f� ` �" <br /> Home Phone: �� 2� `'1" 0 �' "�y�� Alternate Phone: \, (Z� ��(U —/��d <br /> Contractor/:Applica�st Inforriiatiori <br /> � 5� ��- v <br /> Contractor/App.: �)/1`� Contact Person: �� �l <br /> Address: State License#: (�,(n.,,, <br /> ) <br /> •�t� <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> - ' F` TYPES:OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ TemQorarv 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 ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) �Q500 Cubic Yards *ForO-75'Zone-$3p.00 <br /> *Estimated Cost: S � $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+-CubiC 1'ards <br /> ❑ Residential - $30.00 �50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * W ithin 0-75' -�30.00 <br /> I herby apply for a User Defined Permit and I acl:nowledge 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 permii and work is not to start without a pennit; and that the <br /> «�ork vill be in accordance with the approved plan. <br /> �t��-� A,G�� ('Q -- �f -� 7 <br /> Applicant .: -. Date <br /> . Resei.eOrm . (UserDefinedPcrtnitil18/U11 <br /> l � <br />