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of Orono <br /> 41.-15-1;;\ City FOR CITY USE ONLY <br /> 0 J 0 P.O.Box 66 Date Received: ,.-1614(i Permit# P 1033 0 <br /> 2750 Kelley Parkway <br /> �? ► <br /> 5 t Crystal Bay,MN 55323 <br /> 'riv^0,6`i (952)249-4600 Amount $ v4 04C.U.P Filed: <br /> moa <br /> Approved By: //j(Jur r'�Site Plan: 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 /> 4 Site Address: ) (l) ,fpm -vL k �v <br /> Owner: �PrQCQA1l.. f B C_ Mailing Address: fj rrL <br /> City: d(z.0 Zip: 65310 7 <br /> Home Phone: ciS o� - 1-11.2-31). 49 Alternate Phone: 1.5.2- /o - 'g 7- <br /> Contractor/Applicant Information: <br /> Contractor/App.: t---r‘s L. 4-�bF'P ti Contact Person: All l <br /> Address: / u 3C 011-1W1,11-- 6LAID State License#: fa-IP 41/- / 5� - ///5 <br /> City: .1303� Y� Zip: . <br /> Phone: 7/ 3 1/2ey^ A ,2S Alternate Phone: ' /a '2 5-6-- (71 <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake U Retaining Walls n 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 yt Land Alteration I I Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) jz 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 /> work will be in accordance with the approved plan. <br /> Appli0.nt Dat <br /> Reset Form (User Defined Punt,t3/28/04) <br />