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¢�� City of Orono F I Y USE ONLY <br /> P.O.Box 66 Date Received: 7Y U Permit#q 9-Doa�� <br /> 2750 Kelley Parkway l� D" <br /> k.,.:.OzL <br /> °� x Crystal Bay,MN 55323 Amount: $ C.U.P Filed: V c, <br /> (952)249-4600 (,asa� Approved By Site Plan: `"...A <br /> - <br /> Approved <br /> Approval Er Denial 0 <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: l 2.1 l,.. ‘►tcXh%,44.. V \ <br /> Owner: L-.>fa.,D 4, -3---uAl e.. Ckt. . Mailing Address: S4+`42.. <br /> City: C re b Zip: 5 3(O <br /> Home Phone: -- Z'3.s--_3 - Y/Zee Alternate Phone: 703'y9'Z - 2 a 7 <br /> Contractor/App.:(Dtt9 C 6 Contact Person: S <br /> Address: cf S-`b,�•�cJs sL State License#: 0`'/4 <br /> r 1. Zip: . p Expiration Date: <br /> City: l,0 <br /> C4 <br /> Phone: 1 2—(4/ -- C00 9 AlternatePhone: ?(03-zap- 7-1 <br /> ..,. , o 1410A" "! :, �":7"4:111'1'' ',"H� E°mePaK ,, , b A..�?❑ Starw„ ay <br /> to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) op *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ 1200 <br /> ❑ Docks-One Time(Non—Lake Mtka) R Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge ener -User Defined �U, General—User Defined <br /> ❑ Commercial-(Per UBC) 0-500 Cubic Yards 7 *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 .-'v - • •. ce with the approved plan. <br /> 4upr cmit..,omor *2 1 I 09 <br /> Applicant Date <br />