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Nov' 26 07 08: 03p John Vogstrom 651 -686-4595 p. l <br /> ¢0 City of Orono FOR CITY USE OiVLY �e <br /> o P.O.Box 66 Date Receive � P_ \/_l_ / <br /> 2750 Kelley Parkway �/ ' {(LL <br /> .s � T y Crystal Bay,NfN 55323 t Amount. S /C'! C.U.P led. / <br /> seF�4y°� (952)249-4600 _ _ 1 <br /> 4't+a8° Approved By: S Plan: <br /> Recommends: A2prqyal Q� .-Denial ❑ <br /> /V10 <br /> C� 0 <br /> 1/ I nr 1-7 rt., r <br /> rL. ,rvoaa sn9M�t,O cr�oPA <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT�Nv,e j7,X& � x4r*_1 F <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/:Owner Rilbraiation: <br /> Site Address: 0 es Fyk c �� E � 0 90A) Q f t7 fU). <br /> Owner: �U1 A' s USAYt) D U �1�- LC—Y Mailin0Address: 513S ��7ya6pzc> c-_ z)ve <br /> City. wl O C A NL c M IV , Zip: SS <br /> Home Phone: 21(Q l Alternate Phone: 49/ '" S0 S^ ONO <br /> Contractor/Applicant Wonnation: <br /> Contractor/App.: l,'OGr� T �C� 1]b14 C� Contact Person: JO if(1) 06 5ttty`'r <br /> Address: _2060 P01 k-r State License#: gD�Y7 4 8,0(0 <br /> City: 01UN 0 Zip: S�5 57/ Expiration Date: <br /> Phone: (01- — ;_-,50—GI 5 do Alternate Phone: <br /> TYPES OF USER DEFINEDPERMITS <br /> /SiavwCll �,ql✓tI <br /> F-1Stairwayto Lake E Retainirt ails ❑ Ternporary Trailer <br /> Generai-User Defined Surcharge General-User Defined Surcharge_ , General-User Defined <br /> *(Per UBC) *(Per UBC) 3*7 *$30.00 <br /> *Estimated Cost: S *Estimated Cost: $ <br /> PL` S�k.�UogsrtQ�..- e.o. <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zonin¢Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For0-75'Zone-$30.00 <br /> *Estimated Cost:S S50.00(Needs Site Plan) <br /> General-User Dcfined ❑ 501+Cubic Yards <br /> ❑ Residential- S30.00 S50.00(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 understa this is not a permit and work is not to start without a permit,-and that the work <br /> will bMardance-vit t►.t approved plan. <br /> �? <br /> 1/- , 7-0 7 <br /> Applicant Date <br />