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Cit of Orono FQ CI Y USE ONLY /� nl rill <br /> 04 O P0 Box 66 Date Received: 1U�1611)l0 Permit# 4(V L I"1 <br /> S 2750 Kelley Parkway O e0 <br /> 1. pCrystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> 44 fo (952)249-4600 <br /> Approved By: Site Plan: <br /> Recommends: Approval le Denial ❑ <br /> `p'' CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> 1°12' (All permits must be approved by the Building Official and/or Zoning Department) <br /> vJob Site/Owner Information: <br /> Site Address: /� / / W i c-D Hu Asp" Z/e- <br /> Owner: V>,tfr Cl—o1/456 Mailing Address: <br /> 17-14 c-6 t LtDousr'Re- <br /> City: U R 0 Zip: <br /> Home Phone: 3 6-3 — 1 z (-P Alternate Phone: <br /> Contractor/Applicant Information: r <br /> Contractor/App.: 663T/All'SOAP//JU- Contact Person: \M O SEED S, <br /> Address: 3/5-3 ?R 161 T LJ'- . State License#: a Sg O CQ Co 1 <br /> City: A/OU A/D Zip: 5-5-3 G'4 Expiration Date: 3/3/A)//o 7 <br /> Phone: 952 LI72 /J/S Alternate Phone: 012- 6-8/ -5 bf30 <br /> TYPES OF USER DEFINED PERMITS <br /> n 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 E Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) 0 0-500 Cubic Yards *For 0-75'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 work <br /> will be i accordance with the approved plan. <br /> A licant Date / 19/66 <br /> if Ie*n.F:...1 u.....n 1/1 VNdt <br />