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<br /> ,,._ O City of Orono ; ; (,,j-'' t ` '- OR C USE ONLY ,
<br /> O4 P.O.Box 66t Date Received /7i Permit# ��� ADS
<br /> ", 2750 Kelley Parkway A�. o `V
<br /> Crystal Bay,MN 55323 .i 0..
<br /> Amount: C:U.P Filed: ,
<br /> ' e' '. u^ (952)249-4600
<br /> ��arso$ti C/U�`
<br /> Approved By: Site Plan: 4/
<br /> rM CV/£ ppm i‘1.- t s,s tech Recommends: Approval © Denial 0
<br /> p(pc, YW i da b ' (x esl-ro d — no 'p (Ali ve.Viec..) -C doe. co/per m i \- /Lc).
<br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT
<br /> (All permits must be approved by the Building Official and/or Zoning Department)
<br /> Site Address: 2 7 S ,,,-)::\p,,,,,,,,,,--e._ �D
<br /> e
<br /> Owner: R.-,I, � v1.f z_ck.,-,__ Mailing Address:
<br /> City: 0(0/1 D Zip:
<br /> Home Phone: Alternate Phone: `'/0(1 - 7 ci - X37
<br /> Contractor/App.: 1;e..„(` 0,n4,_, a;r,G„�srToc„, Contact Person: ,,,,o.,, k.
<br /> Address: 60 .5�,,4L. cP\- State License#:
<br /> City: +-0ci Zip: SSCt q Expiration Date:
<br /> Phone: (y l2 -36,3.36e2 Alternate Phone:
<br /> �az = er ( e'` r� I , �t i, 1 1 i-, , . !::'5,j711::':.'
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<br /> .. ' �� �Ww.�.,� ..,..,, sanx _. . �� -- -��a _ �5re a�e,, ,'�`, ` � , `,,ruee�ra:
<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: $ *D6 *Estimated Cost: $ -700D
<br /> ❑ Docks—One Time(Non-Lake Mtka) [► '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 [ 5C bic_Y_ards M c.rf- Cn (C1 cry i vi 0-1 S
<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 /> wil e in accordanc- with, e approved plan.
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<br /> 4,--i,,,,,, . ..5?///0
<br /> licant Date
<br /> ttisairihie—JiiMINti)
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