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4 <br /> - P.O.City oBox 66f Orono FOR CITY USE ONLY <br /> Date Received: �,� Permit#��CO 4�y i 2750 Kelley Parkway <br /> -. ,. Crystal Bay,MN 55323 Z t <br /> ti.-)` (952)249-4600 Amount: $ 1 C.U.P Filed: <br /> Approved By: e61400- Site Plan: 7-l 3'04:4 <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 /> Job Site/Owner Information: <br /> Site Address: \0 ‘Zo , • ,,\t J J i,es,,v 4) r c Jho <br /> Owner: %.c G`l `O—CUXd i, Mailing Address: <br /> to )___ 4. in\.14 <br /> City: O'CDv...0 Zip: 55'35- 6-) <br /> Home Phone: q5 2.—`{7(-1,.4.02 Alternate Phone: (e(?--1643—.}) y p <br /> Contractor/Applicant Information: <br /> Contractor/App.: `M+.v.,n.(50,-,,(-e ST'S. Contact Person: 's-..,,... rj,%c.,w. <br /> Address: State License#: <br /> City: ,,) „‘-st,,�,. Zip: ,AAAI Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake FRetaining Walls/r'60"A E Temporary Trailer <br /> General-User Defined Surcharge General-User Definee�b Surcharge General-User Defined <br /> *(Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ 3.50:0 v <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-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 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 <br /> w• ,ill br i• accordance with the approved plan. <br /> C. 61 j 1 Z-aa(4). <br /> Applican Date <br /> Reset Form - (User Defined Pe=t 3/18/04) <br />