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�OCity of Orono FOR CITY Uy$E ONLY <br /> P.O.Box 66 Date Received: W-14-0 Permit# O7 <br /> O µt 2750 Kelley Parkway OQ <br /> ► t��. fi• Crystal Bay,MN 55323 Amount: $ 50, C.U.P Filed: <br /> � 8o�yo (952)249-4600 ^\ <br /> Approved By: .44a.— Site Plan: <br /> Recommends: Approval 21 Denial ❑ <br /> -•-• �1��INS <br /> 0" IWI-5 6}N0 *0,0­VS <br /> 4% S604. I N ,S A&Vel-1 O"L. <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT (( <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: ---3— 7,:rW <br /> Owner: Mailing Address: <br /> City: Zip: 3 S <br /> Home Phone: `�� `- L' / Alternate Phone: 1'� <br /> Contractor%Applicant Information: <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPESOF USER 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 ❑ Land Alteration `��/y D j ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined I ^� 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 work <br /> will be in accordance wi the a rove plan. <br /> 41 <br /> A plicant Date <br /> pew? :.311> <br />