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,¢��` City of Orono FOR CITY USE ONLY `r P.O.Box 66 Date Received: Permit# ��: � 2750 Kelley Parkway � � h��:� � Crystal Bay,MN 55323 Amount: $ C.U.P Filed: ��o (952)249�600 Approved By: p� Site Plan: Recommends: A mval Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERI�IIT (All permits must be approved by the Building Official and/or Zoning Department) 7ob Site/ �flv�ue� � a � �; , . ` �� R., � � �. 9,�� .�, / Y � / � , Site Address: � �� 1 � Owner: ��' � � �"��. �- �� ---� Mailing Address: _J� �o X p� �� �-,� c � C �ror, /�'�h, ciry: d r o h .� zip: - � .- �S�'J�3�� Home Phone• '� �� - � f `" �yd� Alternate Phone: f:� .;l -� � �` • �� ., � .w,�• 'c.�--� Contractor!Applicant Information: Contractor/App.: Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: � � �� TYPES�OF USER DEFINED PERNIITS ,�`- �� `` �� x ��'=� � � ��- ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer General—User Defined Surcharge General—liser Defined Surcharge General—User Defined * (Per UBC) *(Per LBC) *$30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks—42"or Greater �..Land Alteration ❑ Zoning Review Genenl-User Defined Surcharge General-L'ser Defined General-User Defined ❑ Commercial—(Per UBC) � 0-500' -$SO.00(Needs Si[e Plan) *ForO-7S'Zone-$30.00 *Estimated Cost: $ ❑ 501' +_$75.00(Needs C.U.P.) General—User Defined ❑ Residential- $30.00 /o •lr •a3 ❑ Tree Removal � ��(J` Genenl—User Defined � � �Q *Within 0-75' -$30.00 � �'� , I herby apply for a User Defined Permit and I acl�owledge that the information above is complete and accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code;that I understand this is not a pernut and work is not to start without a permit;and that the work will be � cco dance with the approved lan. - �� .�z� ,� Applicant Date �DcSne�.P�.Rr� '