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Q¢O�0 City of Orono .S�2S/e� TOR SE NLY <br /> P.O.Box 66 ` Date Received: ,7 Zy b Permit# (� <br /> '8 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 <br /> �`• ry y <br /> (952)249-4600 Amount: $Sn fes' <br /> U r &P�F`iled: o <br /> Approved By: 11A• Site Plan: <br /> Recommends: A royal Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL%KNIT �. !3 y <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: <br /> Owner: -Te-�V 2S (°1 e Mailing Address: (PL'5- Ton Lo( <br /> City: Dfd,,p Zip: <br /> Home Phone: ( Z. 2,n1� Alternate Phone: �(Z AZO.OZz-�- <br /> A <br /> A ,..�` d <br /> Contractor/AppA eR(-a rC-065&'l SudriPS Contact Person: C-�<<� !ae 5e l <br /> Address: 2193/. 11" State License#: <br /> City: Zip: ' �' 2— Expiration Date: <br /> Phone: 4oY,7- Alternate Phone: i S-Z Y1 7.7 <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) *$30.00 <br /> *Estimated Cost:$ <General <br /> *Estimated Cost:$ <br /> ElDocks-42"or GreaterLand Alteration ❑ ZoningReview <br /> General—User Defined Surcharge —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 /> wor ill b cc anc ith the approved plan. <br /> Applicant Date <br />