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/1 ( r �a K <br /> Cit of Orono t s (Y' : r• <br /> „(6.0---A--, Y OR C Y USE ONLY zc� <br /> 0 P.O.Box 66 l d � Permit#�d�Q � l0 <br /> � "` �(, ;; �,j' Date Receive /� <br /> V. <br /> 2750 Kelley Parkway f 1 �jd .� <br /> ' Crystal Bay,MN 55323 t t t` Amount: ` $__� __ C.U.P Filed: �(j• <br /> �iyu^ (952)249-4600 <br /> Approved By: e Site Plan: V <br /> /1/41 011 E) phren r\- t sS Jew Recommends: Approval Er Denial ❑ <br /> P( vw i W cicn,2.. b.1J 6ansko a n43 p liali revi P.v Cee.. due_ u)/per m l -pew E..C). <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: 27 iS qy\,,,,,,,,--ta_ \�) <br /> Owner: R.,- _ i zzi,.,-,_ Mailing Address: <br /> City: aca°)cD Zip: <br /> Home Phone: Alternate Phone: (10 (I ` 7S.9 - 37 <br /> �,°� � " ;�p�3�cam' "t�l� g r�er c ��-~ ., " <br /> lifirq <br /> Contractor/App.: 1; J\ Orae. ‘,,,Dscloc, Contact Person: ,,,,o,, l k, <br /> Address: / &O sr/4Q,(e-det V State License#: <br /> City: O 4, cv')-tt Zip: SSZq Expiration Date: <br /> Phone: f a- -363-360 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) *$30.00 <br /> *Estimated Cost:$ *40 *Estimated Cost: $ X(900 <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 [ 5 4. jc,1'ards nei tire_ 10 L1r I yt CD-7 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. <br /> t /0.fi d <br /> cant to <br /> tt7sa" 0) <br />