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,��� City of Orono FOR CITY IJSE ONLY <br /> � Q Y.O.Box 66 Date Received: Permit# � <br /> �,, 2750 Kelley Parkway <br /> ��� ��-> � Crystal Bay,MN 55323 � �'� <br /> � �� Amount: $ C.U.P Filed:�,1 <br /> �'���'��,8�,�` (952)249-4600 <br /> � Approved By: Site Plan: <br /> Recommends; A roval Denia] ❑ <br /> � 8�1�.'--�o �S�v� <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 Inforniatiarl: <br /> Site Address: � ��'cJ ��� �' ����-�� <br /> � �z/�a��-� <br /> Owner: �(/Ld� � (l� Mailing Address: <br /> City: �Y V� !�' c � Zip: �5�� �p <br /> r. � �.� . ,� <br /> Home Phoi�e: � ��' �-� ����� . 1 ��'- '`- �-' Alternate Phone: <br /> ��Contractor/Applicant'Tn�ormation: �� � � <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> �YPES OF T�SER DEFINED PERMITS ` .��..�,� ; ' <br /> tairwa to Lake etainin�Walls ❑ Temporarv Trailer <br /> eneral—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) *(Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks-One Time�tvon-i.ake Mcka) ��{^,Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge ��General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- $30.00 $SOAO (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 wark 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 work <br /> will be in accord nce with the approved plan. <br /> � 1 <br /> 1�. � r�� � a-a � n <br /> Applicant Date � <br /> . (User Defined Pemrit OSr�°.'�?j <br />