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p City of Orono f� <br /> �' AI j :FOR C USE ONLY <br /> P.O.Box66 (7— <br /> 0. 0 . DateRecerved:A0/3/O g Permits <br /> . . . 2750 Kelley Parkway <br /> ?- k Crystal Bay,MN 55323 0% <br /> .. <br /> \'"INirk a (952)249-4600 I Amount T 40$ �� 44 <br /> �tiexo I b� C.U.P Filed: <br /> Approved By: E.,./.^-?-Site.Plan: <br /> Recommends: Approval al Denial 0 . <br /> CITY OF ORONO USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Buil ding Official and/or Zoning Department) <br /> Job Site/Owner Information <br /> Site Address: <br /> \Old \\A 0` � ) ` .(.v..)-_, <br /> e r�, <br /> Owner: r Cx. —\ 1efailing Address: t' t �,),,`L J <br /> City: ()COr' 0 Zip: 5, SI) <br /> Home Phone: q5-1- L4))-24 62— Alternate Phone: 6;,( 2--gr-3S47 <br /> Contractor/ijii ca.>zt Inf947.64 601 /;W 1j <br /> Contractor/App.: ---\--.kr-\ c <br /> \1 ..,fC,.S Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ,.= f 7.:?_ t.,ag: .:-. .r 6. <br /> TYPESOF':USER'DEF;TNED PEt .to s Rt';''::. .(.::: ',,.`. .' �. . <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) *S30.00 <br /> *Estimated Cost: $ *Estimated Cost: 5 <br /> ❑ Docks—42"or Greater V Land Alteration E 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 /> ;nor• will in accordance ith the approved plan. <br /> 1 ...ZS\ ic, /1 \-LoDS <br /> Applicant Date <br /> Reset Form (User Demed Permit 3/1M41 <br />