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r ��U City of Orono FOR CITY USE ONLY <br /> /� \ P.O.Box 66 Date Received: C_;Z,S=3 Permit# HO 4AZ of <br /> ��`, 2750 Kelley Parkway � <br /> !R - Crystal Bay,MN 55323 Amount: S `ti C.U.P Piled.-"'� <br /> r�,r ^f (952)249-4600 <br /> �� `y Approved B : LL) Site Plan: <br /> Y <br /> Recommends: Approval E Denial 0 <br /> (cct.Ceoi /C/to <br /> CITY OF ORONO- USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: c. 1.'L_ 1 L J <br /> Owner: 1� Mailing Address: /c c.i_ i 7 ;/ . 2,7 <br /> 1 <br /> City: 0/9 on)(..) Zip: <br /> Home Phone: '152 - '172 001 Z Alternate Phone: z -.S'i D- 3'100 <br /> litla <br /> eA � . 1, ,q,,,,:,,!,!,-,.,:,.. of <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <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 Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge Gen al-User Defined General-User Defined <br /> ❑ Commercial—(Per UBC) M 0-500'-$50.00(Needs Site Plan) *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ ❑ 501'+-$75.00(Needs C.U.P.) <br /> General—User Defined <br /> ❑ Residential- $30.00 <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> i-, ,''y) -. ' 2. i- ,(( 1)% . (- , (-, ,. 1 <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 /> Li <br /> AppliAant Date <br />