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City of Orono I FOR CITY USE ONLY <br /> Q P.O.Box 66 Date Received: qPermit# <br /> f 'AFa 2750 Kelley Parkway <br /> 46 A <br /> Crystal Bay,MN 55323 <br /> (952)249-4600 ;l f' Amount: $ C'` C.U.P Filed: <br /> i4,�o4 ! <br /> Approved By: Site Plan: <br /> Recommends: A rova Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department), �} <br /> t "/r <br /> ,lob Site%Owner Information: <br /> Site Address: o 1 0'70 To�IC•¢wrd Ro -� <br /> o:.vv�lfli (=J �/�Vh'�'+�S ➢— /Y)'�LlON �t(OBce��B�� <br /> Owner: i l' G(11GL,/ 1 ✓+`�(�yN G/1YV5/N(�— _Address: <br /> /o do DbN���✓s`-6ZP'� �o� o A�-'v/c.�c,✓A- �01J� <br /> City: ol: arv0 ; n-1rU . - Oa o,.)01,. Al-111) <br /> Home Phone: C9s-- �{?3 S'3 2 c� A tz r Phone: ( �Sz, q-7 <br /> Contractor/Applicant Infortiiation <br /> Contractor/App.: �o4,�'_ ' Contact Person: l? <br /> * C2Ls 01) <br /> Address: 1-16 y zap Svn� ��� State License#: z o 3 9 0 9 a <br /> City: 6.X0�t.S Adie Zip: Expiration Date: 0--yw 7 <br /> Phone: g5o , ` M 2- Alternate Phone: `�!(oo <br /> TYPES OF U$ER DEFINED PERMITS <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 1'71 Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) 0-500 Cubic Yards *ForO-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 willbe i accordant ith the approved plan. i <br /> 74 <br /> Applicant Date <br /> Reset Form (User DermpdPearORIvo4) <br />