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\Q 0 City of Orono FOR CITY USE ONLY b ql Lig <br /> rico* <br /> PO.Box 66 Date Received: 2*-0/44S-. Permit# 4UC(��� <br /> 2750 Kelley Parkway <br /> ? ,t Crystal Bay,MN 55323 <br /> 1kloi`� (952)249-4600 Amount: $ C.U.PFiled <br /> : <br /> Approved By: s 14 Site Plan: 9• 5 - '''S- <br /> Recommends <br /> 'Recommends; Approval Denial ❑ <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: \0\D L...3\k\ c.a.J L) -- ..i\k.JQ. Oc&4N-0 °3 5 3 <br /> Owner: C , , (0 ( ,, Mailing Address: \c 0 ;,�;.A\a„J L,X 3t✓•? <br /> City: <br /> C v t\ Zip: :J X5 <br /> Home Phone: (,\7_— (04.)--LL-2 -X Alternate Phone: 6\2-530-)-7?� <br /> , Info r6I w j-----,;,',. <br /> • <br /> Contractor/App.: Contact Person: -c'..,1 S;- -Q_v-N <br /> Address: State License#: e ysr cz.va+,rtZc..; <br /> City: \�-\\�,�,� Zip: Expiration Date: <br /> Phone: qct. Z 7 -?,(cu( Alternate Phone: <br /> :.. : _ . EN. DjT2r,V Iraq <br /> CCI It-ig <br /> ❑ Stairway to Lake r ' xi Retaining WallsTemporary Trai r`_ <br /> General-User Defined Surch 1 17,, General-User Defined Surcharge General-User Define ;. <br /> *(Per UBC) /54 1tJ/ *(Per UBC) *$30.00 111 <br /> *Estimated Cost: $ *Estimated Cost:$ 3,5OP.i~) <br /> ❑ Docks-42"or Greate* p y' t ] Land Alteration 111 Zoning Review <br /> General-User Defined Surcharg 0• General-User Defined General-User Defined <br /> ❑, Commercial—(Per UBC) W 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ards <br /> ❑ Residential- $30.00 $S101L.Wee ii-P:j -.) <br /> W1 tM <br /> ❑ Tree Removal ?O.' /41% .31='` "^) - <br /> General-User Defined SI 1441 WI d-34 l-lv-A3 k h- <br /> . Within 0-75' -$30.00 . ( <br /> nck,..,)all- GD' In-- .1)` 'I li <br /> S. <br /> I herby apply for a User Defined Permit.and I acknowledge that the information above is complete and <br /> accurate;that woo will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building •,•• tha I u,derstand this is not a permit and work is not to start without a permit; and that the <br /> work wi :e in ac'o , ,nce with the approv plan. <br /> l'" < eA * 47/,,,,. 7- ),/ 7_00s- <br /> App ca Date <br /> t,. 1 ? <br /> ; , ms 4 — ' ,. <br />