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OCity of Orono OR CITY U ONLYIV <br /> t <br /> 040 P.O.Box 66 Date Receiv ° »i Permit# ? ! <br /> 2750 Kelley Parkway U' 1 <br /> Crystal Bay,MN 55323 <br /> <t� do (952)249-4600 Amount: C.U.P Filed: <br /> -t Approved By: Site Plan, <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 /> lob Slte Owner Infoirnation <br /> Site Address: <br /> Owner: SC �S�'✓� Mailing Address: r &0j 5 ­:Z,G t/ a C e AV <br /> City: Zip: 5 C/ <br /> —T <br /> Home Phone: �v�-" (� L(6-1 CC) Alternate Phone: <br /> Contractor/AppycanCTnforriatlon,. <br /> Contractor/App.: A)�+U:ZkC=v :P�2�nvc(y *Contact Person: _� "te C3 <br /> Address: 1J C/R S S State License#: <br /> City: v:" j 1W Zip: 5.S 4a_Q_ Expiration Date: <br /> Phone: -76>>--52/�-(TQna Alternate Phone: 76 3 -�V'2-60 57 <br /> TXPES OF.09 DEFINED`PERIVITTS <br /> Stairway to Lake Retaining Walls ❑ Temporary Trailer <br /> t� General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) ��, *(Per UBC) �, *$30.00 <br /> *Estimated Cost: $_IT� *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 l in accordance ith the approved plan. <br /> Applicant l` Date <br /> Reset Form Ri n*r,nadp«m;t3ns/o4) <br />