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lee <br /> 0� City of Orono I FOR CITY`USE ONLY <br /> I <br /> C)‘ 0 P.O.Box 66 ! I , Date Received: Permit# c a/e) -t::)00 O 9 <br /> 2750 Kelley Parkway ) 11 <br /> Crystal Bay,MN 55323 5 <br /> 2,1 '1° Amount: $ C.U.P Filed: fo ' /Y 7 <br /> ren,'o. o (952)249-4600 (iki e.CI' V <br /> Approved By: Site Plan: ____ <br /> et°k 5( _,„$,-- <br /> Recommends: Approval gi Denial ❑ <br /> 0 q-TOlel Fiook.- oivi-i 1 Al'Y <br /> J 4 CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> t <br /> Site Address: )ac) W1t.,-- ,per 1 U X <br /> l r( <br /> Owner: Mailing Address: <br /> City: A P, 2A- A- Zip: cc3 q <br /> Home Phone: LO \ — (z?)vL- 5--(0 3 Alternate Phone: C.71; - 7 7 --- C176 <br /> Contractor/App.: p,.c.,3 h; Contact Person: i'Ar2-Vit\ �1\ 11 Ftpp • Ockitt,k 1 <br /> Address: Lls-6 �ovJA 1441( ()State License#: 2 ?d 1 (j v y <br /> City: p,r —c� Zip: S S ,5 7 I Expiration Date: 4M <br /> Phone: -7 1 -7 .7 c/gd C Alternate Phone: LI)- Ak ( - ' V <br /> ❑ Stairway to Lake ❑ Retaining Walls n 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 /> ❑ 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 W. 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 Nerby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> ac urat ;that the work w' .e in conformance with the Ordinances and Codes of the City and with the State <br /> Bu ld. g C I de;that I un.(-rs(.nd t pis is of a permit and work is not to start without a permit;and that the work <br /> will '4e in a,cordance wito t e ap.,ove plan. <br /> A <br /> , l . ■_ . (d Q - a 4 _ 2 0 \0 <br /> Applicant Date <br /> (User Defined Permit 05/08/09) <br />