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,�0� City of Orono FOR CrrY USE ONLY <br /> 0 P.O.Box 66 Date Received: 5 ./4 0 Permit#! q,?"X <br /> 2750 Kelley Parkway <br /> a Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> &Mw sf d. <br /> Recommends: Approval ❑ Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> M <br /> M., <br /> Site Address: FA- <br /> Owner: ` �p t(l l�� Mailing Address: AS c3t�6 V <br /> City: nyn\-1 n Zip: <br /> Home Phone:U a ' b 1� Alternate Phone: <br /> +vMW ' <br /> . <br /> Contractor/App.: 'E) e Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <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—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge a ral—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) 0-500 Cubic Yards *For0-75'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 /> wooill be in accordance withzz le') W <br /> t approved plan. <br /> Applicant Date <br />