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Council Exhibit A City of Orono Zoning Permit Application /�l Mailing Address: Permit number: �O` V PO Box 66 Date received: Crystal Bay, MN 55323-0066 Escrow#and #''^�^, Street Address: amount: GG/ > 2750 Kelley Parkway Permit Fee: "' A— ytn I Orono, MN 55356 F,�' Approved by: kFSHO� Fax: 952-249-4616 Notes: Main: 952-249-4600 www.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. (Please print.) Job Site Address: Lli{(lto Fp, e5+ te,.p.- (_e.,,,4,nc, (�rDr7� MaU 5536 CONTRACTOR/APPLICANT INFORMATION: Name: TF_ Phone: 612_ s)ng Iti-EK7- Fax: Address: /„I?S Sto c L't City: '� dt^c.e, ZIP: 55� rt Contact Person: _Toe Contact's phone number (nIZ 3O$ W's Email -,ae-Qh.i eco, Applicant is: Contractor omeown >� (Circle One) PROPERTY OWNER INFORMATION: Name: :306 CJ L_,,_-. Phone(day): (--12 bQ1 -1Y9 Mailing Address: (a/-7 S 54-o„o at !Vg dr.&,�,,J-e_� ZIP. Email and/or Fax ,op ft,eh6N,c pM Overall Project Description: t2e4pJac, dr�V �„� 0014- sod-e,wc, (c Ce,1XrAk Check BoxTYPE OF PERMIT COST* Dock, Residential-Permanent dock on any lake or initial seasonal dock not on $50+engineering review costs Lake Minnetonka (permanent dock requires CUP Dock, Commercial $50+engineering review costs Escrow for erosion control and engineering review costs $2,000 Hardcover Permit: Driveway, Patio, Sidewalk, Etc.(New or Replacement) No charge Also re uired is a Minor or Major Land Alteration Permit Land Alteration, Major(grading,filling, or excavating)more 500 cubic yards or $50 more than 10 cubic yards in lakeshore setback(also requires CUP) Escrow for erosion control and engineering review costs As determined by CUP Land Alteration, Minor(grading,filling or excavating)-500 or less cubic yards $50+engineering review costs outside of lakeshore setback or less than 10 yards in lakeshore setback Escrow for erosion control and engineering review costs $2,000 Retaining Wall measuring under four feet require a zoning permit. $50+engineering review costs Retaining walls measuring more than four feet(from bottom of footings to top of wall)require a building permit. (Tiered retaining walls are considered one wall unless the walls are separated by twice the height of the lower wall.) Escrow for erosion control and engineering review costs $2,500 Stairway to Lake (New or Replacement) $50+engineering review costs Escrow for erosion control and engineering review costs $2,000 Structure Permit for other structures not requiring a building permit but $50+ engineering review costs regulated by the zoning code(including, but not limited to accessory building of less than 120 square feet, detached deck or platform and sport court) Escrow for erosion control and engineering review costs $2,500 Tree Removal or other vegetation removal in 0 to 75 foot zone No charge. Temporary Construction Office/Trailer associated with building permit) $30 (over) *Permit fee will be collected when the permit is issued. Updated: November 30,2012