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' p City of Orono <br /> ,$ �t Ftp_t- 1,'�t"/Y�SE ONLY <br /> or, <br /> p P.O.Box 66 Date Received: Permit# <br /> 2750 Kelley Parkway J <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ C.U.P Filed: <br /> Approved By�V1-'<Site Flan: <br /> Recommends: Approval40 Denial <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information} r <br /> Site Address: 363':5- / 0G d 60,40 (2-AdAZO CAUVI A46) ZIAI S5 3 V <br /> —16 3 S T'a G o R 04-9 <br /> Owner: M41Z Y SC /f 0,^1x'1( Mailing Address: w+Yz-I,-T* ,I / <br /> City: _0 12 0,'1/t) Zip: <br /> Home Phone: qLZ - 4/71 7 z Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: S (F/C- Contact Person: <br /> Address: 3 G 3 S %Oe-a g aA- ' State License#: /y/Y- <br /> City: 09 d,1V C) Zip: SS..?4/ Expiration Date: <br /> Phone: �SZ- �/7/ �Z��' Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retainin 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-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost:$ $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 /> 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 <br /> work will be in accordance with the approved plan. <br /> a� /v .3/- d F- <br /> Applicant Date <br /> Reset Form <br />