2006 - P10438 - land alteration - Laserfiche WebLink

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.veiK , Q City of Orono FOR 4ITY USE ONLY v. oil- 0 P.O.Box 66 Date Received: /Up0 Vir. Permit# j t��-13 Ct.,,„ 2750 Kelley Parkway Fr 1QN Crystal Bay,MN 55323 1 tl R i L y (952)249-4600 0 I Amount: $ 50"-- C.U.P Filed. ` Approved By: W.G Site Plan: 10-1/,oco Recommends: Approval E Denial 0 CITY OF ORONO -USER DEFINED/GENERAL PERMIT (All permits must be approved by the Building Official and/or Zoning Department) Job Site/Owner Information: (Z-efe Site Addre 2 D S V v / / , ? 1---t,.61.0___j Owner: Cv Mailing Address: t. City: 0/ 6"71, 0Zip: _G-c.3 / / Home Phone: ! 5-2--- 7 /C) 3 Alternate Phone: ______— Contractor/Applicant Information: Contractor/App.: Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: TYPES OF USER DEFINED PERMITS ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporary Trailer General-User Defined Surcharge General-User Defined Surcharge General-User Defined *(Per UBC) * (Per UBC) *$30.00 *Estimated Cost: $ *Estimated Cost:$ ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review General-User Defined Surcharge - al-User Defined General-User Defined ❑ Commercial-(Per UBC) `1 0-500 Cubic Yards *For�Zone-$30.00? *Estimated Cost: $ $50.00(Needs Site Plan) General—User Defined E 501+Cubic Yards ❑ Residential- $30.00 I` $50.00(Needs t . ') r �, / ❑ Tree Removal General-User Defined q.lit4444/ r _ A1 e c *Within 0-75' -$30.00 A� .w�n.1 4 I herby apply for a User Defined Permit and I acknowledge that the information above is complete and .,L_ . accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State/�/"a f Building Code;that I understand this i not a permit and work is not to start without a permit; and that the l / e' G SA 'e .ill be in accordance w•,h t. ./:proved plan. k144/) "► aj"' 41111116 v+, ' / ( O ‘ Applicant Date Reset Form (User Defined Pearn 3/16/04) / �