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E <br /> O¢OO City of Orono F RE ONLY <br /> TY <br /> P.O.Box 66 Date Received: a Permit# <br /> 2750 Kelley Parkway C <br /> ` Crystal Bay,MN 55323 Amount: $JUr Od C.U.P Filed: <br /> os (952)249-4600 <br /> Approved By: Site Plan: <br /> Recommends: App royal Pro,, Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> i <br /> Site Address: M5� TU&A)h#n? LCA <br /> Owner: 99-yL .490by IMLJ Mailing Address: <br /> City: ozown Zip: s6MISJ <br /> Home Phone: Alternate Phone: f ,,L a9a /S/3 <br /> Contractor/App.: Iku��? 4 cu c P-t. Contact Person: <br /> Address: S'o a State License#: <br /> City: Q&11-/a Zip: Expiration Date: <br /> Phone: 7G-3 97,x 33G� Alternate Phone <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 ❑ Zoning Review <br /> General—User Defined Surcharge Genera —User Defined General—User Defined <br /> F-1Commercial—(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 /> � N0 � eM YJW McCUt1l�, CLoA�► �M/l,S� � (,CesJ �'ra� <br /> ❑ Tree Removal -- \,/� h <br /> General—User Defined ok'r V(' W ool' -`�r,�6 t`"o Q <br /> *Witbin 0-75' -$30.00 ` tw ' S e A V SiAf' WAfensn5<�qey"F'Q <br /> 0,5 S V n Ah RG f( M,OLh <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 undeggald this is not a permit and work is not to start without a permit;and that the work <br /> Will e,in accordance d plan. <br /> Applicant"" Date <br />