Laserfiche WebLink
11 <br /> o City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: 8-0s-0'1 Permit# <br /> t6,'" <br /> 2750 Kelley Parkway <br /> ' Crystal Ba ,MN 55323� Y Amount: $ C.U.P Filed: <br /> o�6o (952)249-4600 /� <br /> Approved By: Site Plan: <br /> Recommends: Approval kg. Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Infornation: <br /> Site Address: 404-5 U\-) M> <br /> Owner: EL-� Bb? gy ,p }- Mailing Address: 04 T2 -JM <br /> City: V ?-01\16 Zip: 55 351 Vim" <br /> Home Phone: t — 41/e 40¢1 Alternate Phone: q`5 Z— 41 O 69749 -- (g'iCa <br /> 12 <br /> Contractor/A licant Information: 3 �� <br /> 3 �J <br /> PP <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <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 /> (l Docks-42"or Greater dLand Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) 0,0 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- S30.00 $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 /> will be in accordance with the approved plan. <br /> :/CAA C34 <br /> Applicant Date <br /> (UserDefned,Per A,ItW04) <br />