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�I a �iik" -4j-- <br /> 0 O City of Orono FOR CI Y SE ONLY <br /> P.O.Box 66 j' Date Received: qj Permit# pmaa <br /> 2750 Kelley Parkway 0 <br /> Crystal Bay,MN 55323 DI 3 O <br /> rY Y Amount: C.U.P Filed: <br /> (952)249-4600 <br /> Approved Byif; '-pS <br /> Recommends: Approval Denial ❑ <br /> �Q/1 �6 CCcfi <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) oZ S <br /> r <br /> . . '� OL'u <br /> C �-3o6a <br /> Site Address: 0 ed a-Y <br /> Owner: rY4 tlb-e�7� MailingAddress: � a! a , <br /> City: V y-O ny Zip: <br /> HornePhone: o( ��l�� '?j c/d Alternate Phone: t0 �°� ' �� V6 v2-( <br /> q <br /> ave, <br /> Contractor/App.: n <br /> � � Contact Person: <br /> Address: pj� State License#: <br /> City: _ �� „ Expiration Date: <br /> Phone: �j d - S3 Alternate Phone: <br /> F-1Stairwayy t <br /> o Lake <br /> Retaining Walls <br /> ❑ Tempora <br /> y 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:409 1 <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 <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 with the approved plan. <br /> Applicant Date <br />