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�0 City of Orono FO_ rryE ONLY f X19 <br /> 0 P.O.Box 66 Date Received: Permit# <br /> 2750 Kelley Parkway <br /> SOCrystal Bay,MN 55323 001 (00 <br /> (952)249-4600 Amount: $ � �'ii��. C.U.P filed: <br /> Approved 134eA 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 /> Site Address: Ad S Q•✓ A �NO <br /> Owner: 41� s Mailing Addres ` aco <br /> XO /'� • <br /> City: �L71n Zip: eDf '*P/ <br /> Home Phone: $��-AWYO Alternate Phone: <br /> Contractor/App�. 4 s SaN/ <br /> /�� Contact Person. <br /> Address: ApAk.P-•;Q;��tate License#: <br /> City: Zip: Expiration Date: <br /> Phone: ��S'47*"r/0 7 Alternate Phone: <br /> ❑ Stairway to Lake ❑ Retainina 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 General—User Defined General—User Defined <br /> El 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, c will be in conformance with the Ordinances and Codes of the City and with the State <br /> Buil ' g o ,th this ' not a permit and work is not to start without a permit; and that the <br /> wor accor ance with t pproved plan. <br /> A licant U, Dat <br />