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04/20/2005 WED 4:41 FAX General Mills 2o06/006 <br /> 4.. <br /> . <br /> O�` City of Orono FOR9YUtNLY /1 TLL� ltri <br /> , 4-.. Crystal Bay,MN 55323 ,/', / <br /> „r,..,,,:'..„...(77:. (952)249-4600 AMUUtlt: C. Filed: <br /> Approved By:�y�f /'Site Plan:5•1,' CS <br /> Recommends: .&ppprovei Denial C <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> l Job Site/Owner Information: I <br /> Site Address: .__.._; 5 ._...__Gk%�5Lci.hf_...:S4_. <br /> • <br /> Owner: Kc.1J t+t 4aU(t'-t ,fop,:irf(.U Mailing Address: ,?� �- `i` , /�i <br /> City: Na IY (.roJ. Zip: c-5-3( 1 <br /> Home Phone: 423._if tl( '1102 51..__-.___ Alternate Phone: ?(s 3 ` )L Li--??.5.1) <br /> Contractor/Applicant Information: <br /> Contractor/App.:,_--An-t-30-1/1/lc- , .... Contact Person: 1?--tyun J C c z. <br /> Address: a "7‘7. 0 6ctIti .ac. State License#: <br /> City: eoe-kro� _ Zip: _S.S373 Expiration Date: ----------- ---.-----. <br /> Phone: (6IZ) Cl--Z7cia Alternate Phone: . SZ)`?`ff 6oa-I <br /> � <br /> —-- wtt J--Cel I �-- .— --_. <br /> --- _ __— ...__ �...—._._. <br /> 1 TYPES OF USER DEFINED PERMITS <br /> Stairway to Lake ERetainintt Walls TemporaryTrailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined*(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost:$ S CO. *Estimated Cost:$ <br /> E Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General•-User Defined Surcharge Ge oral-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 De ikd L 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs CU P.) <br /> ❑ Tree Removal <br /> General--User Defined <br /> *Within 0-75'-$30.00 <br /> 1 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 accordance with the approved plan. <br /> </a 7/0c- <br /> App App is a Date <br /> Reset Form (Usu.DctirmiPermit 3115tra) <br />