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~'OR CITY USE ONLY City of Orono P.O. Box 66 Date Received: ____ Penn it# ___ _ 2750 Kelley Parkway Crystal Bay, MN 55323 (952) 249-4600 Amount: $ ___ _ C.U.P Filed: __ _ Approved By: ____ Site Plan: ___ _ Recommends: A roval D Denial D CITY OF ORONO -USER DEFINED/GENERAL PERMIT (All pe1111its must be approved by the Building Official and/or Zoning Department) I Job Site/ Owner Infom1ation: Site Address: Owner: City: (];, 12cl '?_vu, ~k ll1v1 Mailing Address: Zip: Home Phone: Alternate Phone: I Contractor I Applicant hlformation: Contractor/App.: ?r //ag lfufJJ Contact Person: Address: /J.. S-loj& --;.+ State License #: City: Phone: Zip: /11//.(,.1. 4 7, -J-5 <";;-c Expiration Date: Alternate Phone: TYPES OF USER DEFINED PERMITS·••· D Stairway to Lake General -User Defined Surcharge * (PerUBC) *Estimated Cost: $ ___ _ D Docks -42" or Greater General -User Defined Surcharge D Commercial -(Per UBC) * Estimated Cost: $ ___ _ General -User Defined D Residential -$30.00 D Tree Removal General -User Defined * Within 0-75' -$30.00 D Retaining Walls General -User Defined Surcharge * (Per UBC) * Estimated Cost: $ ____ _ ·,~ Land Alteration General -User Defined J;;j~ 0-500 Cubic Yards $50.00 (Needs Site Plan) D 501+ Cubic Yards $50.00 (Needs C.U.P.) - I(<! cWr111 wlt- :10 d I '?/7 <or- D Temporary Trailer General -User Defined * $30.00 D Zoning Review General -User Defined *For0-75' Zone-$30.00 I herby apply for a User Defined Permit and I acknowledge 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 permit and work is not to start without a pennit; and that the work will be in accordance with the approved plan. dav,Lg,. ~ 7 /2-o /4.; Applicant Date