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ab <br /> O¢OCity of Orono FOR CITY USE ONLY <br /> O ' <br /> P.O.Box 66 Date Received: Permit# <br /> �c. 2750 Kelley Parkway <br /> �vy? Crystal Bay,MN 55323 5 �' <br /> iw o 952 249-4600 �/" <br /> ir�o ( ) Amount $ C.U.P Filed: <br /> Approved By: MA V040- Site Plan: <br /> Recommends: Approval Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Oficial and/or Zoning Department) <br /> lob Site 1 Owner Information: <br /> Site Address: Zo�6 /W� ZA -1--A o--V eD <br /> ALni.zi- <br /> Owner: 1N dO�S Aling Address: <br /> City: n r 0 0 Zip: <br /> Home Phone: 0:,JAlternate Phone: <br /> Contractor/Applica>zt Iriformati <br /> _ . <br /> Contractor/App.: 01A� "\ GO�S - Contact Person: <br /> Address: �7YdT� e; State License#: <br /> City: ���"'Co Zip: 32'1 Expiration Date: <br /> Phone: ��— ZCp� �� �` Alternate Phone: <br /> :TY <br /> 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 /> ❑ Docks—42"or Greater 11 `Land Alteration ❑ Zonine Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For O-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 a permit and work is not to start without a permit; and that the <br /> work will be in accordance with the approved plan. <br /> ApplicaR <br /> .p Dateeset Form (User DeFmed Petmi t 3118!031 <br />