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' ria - <br /> 04� City of Orono FOCI SE ONLY <br /> P.O.Box 66 Date Received:��Z Permit O p <br /> �U� S <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> (952)249 4600 <br /> Approved By: Site Plan: <br /> -3- �_ _ C� Recommends: Approval 0 De a ❑'' <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT .../...-64/1/44c_ 5 <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> 4 *te/'... ' ea',` i %fie. '� !/ <br /> Site ddress: ,5L(F‘5 ,c ,,mss P <br /> Owner: ICK /' Mailing Address ey¢,l.9�, ..,-.47-1._____-) <br /> City: O Rol,v Zip: )-=----? ( o)-- <br /> Home Phone: ��- ? — 305-1) Alternate Phone: 56,-- - <br /> Contractor/App.: 444 4f 2b S Contact Person: <br /> Address: o2`1 LOA - , ..' State License#: <br /> City: Okty4,0 Zip: `5-`7-357o Expiration Date: <br /> Phone: Alternate Phone: <br /> a .iy2 ) Ys »r Y 9 % X 31 fr . 3 _ <br /> -� �'' �„ " �t r3�. Q- e z ... °�� �,.a .E..�.v� � A 4� IN ..4.E"a"'". �, •,4 ii"V.� .3fi. .-, <br /> 1 <br /> El St <br /> to Lake <br /> ❑ 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 /> I <br /> Docks-One Time(Non-Lake Mtka) III Land Alteration III Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) N. 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;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 ape rmit and work is not to start without a permit;and that the work <br /> will be • accordance with the approved plan. <br /> //-Aci-- 0 ?' <br /> Applicant Date <br /> N $i*O9l <br />