Laserfiche WebLink
,¢�� City of Orono F C TY USE ONLY <br /> t P.O.Box 66 � <br /> � � Date Received: ���!" l Permit#��I���l�,�/�/y � <br /> �„1 2750 Kelley Parkway '7—�� <br /> � '����� � Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> ���`�}�y� (952)249-4600 <br /> o$ <br /> Approved[3y: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT y� � <br /> (All permits must be approved by the Building Official and/or Zoning Department) ��1\/ ✓�� <br /> Job Site/Owner Information: �"`'� a �� Gv <br /> Site Address: ��� �7"(��� _r�6��R�� �Q . <br /> Owner: �l/ � I' ��I� Mailing Address: �5' v�d hs ��a� QD , <br /> City: ���1� 1" 1�1.(�) Zip: �-���� - G lv 7 � <br /> Home Phone:C�S�� �D `1 �` ��f U Alternate Phone: �- fU(Z ���o ' �y U <br /> Contraetor/Applicant Information: � � � � <br /> Contractor/App.: ��� � Contact Person: <br /> �� <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMYTS `�� <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporary 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—One Time(tvor,-take Mtka) �nd Alteration ❑ Zoning Review <br /> General–User Defined Surcharge Ge ral–User Defined General–User Defined <br /> ❑ Commercial—(Per UBC) �A-�98 Eubic.Yards y,, *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) /c� ` <br /> General-User Defined � ❑ 501+CubiC Yards (3� <br /> ❑ Residential- $30.00 $50.00(tveeds C.U.P.) <br /> ❑ Tree Removal <br /> General–User Defined <br /> *Within 0-75' -$30.00 <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 work is not to start without a permit;and that the work <br /> will be in ordance with the approved plan. <br /> � D <br /> Applicant Date <br /> tus«�t�er�„w��c�stos�os� <br />