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,��� City of Orono ��FOR CITY USE ONLY <br /> O; O P.O.Box 66 �yY�`�� Date Received: � /0 Permit# �v���� <br /> � ���, 2750 Kelley Parkway r� <br /> � 13��i�� F Crystal Bay,MN 55323 �//,�-/`�Amount: $ f�'z•��`'C.U.P Filed� <br /> ` �'�,,�.r��;��y�` (952)249-4600 <br /> f <br /> ���$ Approve d By:���ite Plan: S''1"o S' <br /> Recommends: A roval,[� Denial ❑ <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 Infornlation: <br /> Site Address: 1 '�' `1 a �J�� a ��k ,�a� <br /> Owner: �; � ('�- �� �e„ Mailing Address: S;t.+�.�_ <br /> City: OlLan� Zip: �=� 3`� ( <br /> Home Phone: �� Z - -��� -- �a o 3 Alternate Phone: <br /> Contractor/Applicant Information: � <br /> r <br /> Contractor/App.: ���,�o�" �c�„ti� sa.°-�C�ntact Person: �,1 i.�, C�rx�.�h <br /> Address: 31 S 3 ��vc.a�( LQ^^�- State License#: <br /> City: c Zip: 553�`f Expiration Date: <br /> Phone: ��� - ��� - � � ► g Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> �tairway to Lake ❑ Retainin�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: $ =��6�' *Estimated Cost: $ <br /> ❑ Docks-42"or Greater ❑ 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 /> * EStlmated COSt: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+CubiC Yalds <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Within 0-75' - $30.00 <br /> I herUy 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 ac anc with the proved pla . <br /> , � /� �� �_ <br /> Applicant Date <br /> (User DeSned Pemtit_3/18/Oa) <br />