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fa 111/ <br /> j AA`` City of Orono FOR CITY USE ONLY <br /> / ` 'O P.O.Box 66 Date Received: Permit# <br /> 27.50 Kelley Parkway <br /> IA iy' i Crystal Bay,MN 55323 <br /> +t' „ (952)249-4600 Amount: S C.U.P Filed: <br /> Approved By _ _ Site Plan: <br /> Recommends: Approval 0 Denial 0 <br /> CITY OF ORONO- USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official andior Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: 3165 North Shore Drive <br /> Owner: Wagener Properties, LLC ling Address: 12520 Wayzata Blvd. <br /> Minnetonka 55305 <br /> City: Z p: <br /> Home Phone: (952)543-7896 Alternate Phone: (952)475-1907 <br /> Contractor/Applicant Information: <br /> Contractor/App.: Counsel Peter W.Johnson <br /> pp.: Contact Person: <br /> Address: 15250 Wayzata Blvd., Suite 103 State License#: <br /> City: Wayzata Zip: 55391 Expiration Date: <br /> Phone: (952)475-1907 612-741-19 0 7 <br /> Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <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) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> O Docks—One Time(Non—Lake Mika) ❑✓ Land Alteration ❑ 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 151 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(NeeelsC.U.P.) <br /> VED <br /> inTree Removal <br /> General—User Defined �p s;j 2®®( <br /> *Within 0-75'-$30.00 SEP 2 eP <br /> t .rrY OF (SONG <br /> 1 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 ermit and work is not to start without a permit; and that the <br /> work wi lobe inacco nce wit th a rov plan. <br /> 2'2. /C� <br /> 9 / 1 <br /> Applicant r W. Johnson, G&ieral Counsel Date <br /> 3IO43 <br />