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do 13 <br /> t . 4- <br /> Og0C City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: �� Permit# f t <br /> 2750 Kelley Parkway li <br /> 3 Crystal Bay,MN 55323 <br /> (952)249-4600 ��J y)� ` Amount: $ C.U.P Filed: <br /> C ZLG Approved By: Site Plan: <br /> y <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 /> z <br /> �3�<, a , ','; <br /> Site Address: r� � �(�'��� j�(,�� �( (� , /Ptj <br /> Owner: 5 1>> Mailing Address: &0j S � ���� P <br /> City: I V446r/7(., Zip: C/ 10/ <br /> Home Phone: % ��-'��(� - t(&Co Alternate Phone: <br /> i <br /> Contractor/App.: �� V ` L�'oc�i/kairv*-Contact Person: e <br /> Address: G &j,4 sS State License#: <br /> City: 600�-1 Qc,((t Zip: 5S t-fa-tt�- Expiration Date: <br /> Phone: -76 >->-5 yy' �^ Alternate Phone: <br /> V <br /> Stairway to Lake Retaining Walls 7 `)� ❑ Temnorary Trailer <br /> L General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) Ap *$30.00 <br /> *Estimated Cost:$13, *Estimated Cost:$ 500 <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 C94;that I understand this is not a permit and work is not to start without a permit; and that the <br /> work In accordance ith the approved plan. <br /> 1 �a g�06 <br /> Applicant � lui a Date <br />