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,¢�� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 <br /> .�� � 2750 Kelley Parkway Date Received: Permit# <br /> • �������',�-� Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> L_ �y (952)249�600 <br /> `�8� Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Officiai and/or Zoning Department) <br /> Job Site,�Ow�er oimation ''`` �� <br /> ���.. �� - �,�� <br /> -,�.�- � <br /> Site Address: ,���� �-��i,�J�� ,�-�<�r� <br /> Owner: _��-���c.,' CJ fl����Iailing Address: <br /> � �� <br /> City: �/� �..-v�, Zi 5�:���� �,_: <br /> P� <br /> Home Phone: �Sz ��� ���-�` Alternate Phone: �-J� C-7L - /G� 7 <br /> Contractor/Applicant Information: <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> �� ' � ' � �� ��' TYPES OF USER DEFINED��PERNIITS :�,'; �_; v� .. ;.. �� ����� � <br /> ❑ Stairwav 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: $ *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'-550.00(Needs sice plan) *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ ❑ 501'+-S75.O0(Needs C.U.P.) <br /> General—User Defined <br /> ❑ Residential- $30.00 �� � �'�«- y��f <br /> ❑ Tree Removal �� S�� �T ��S/�� <br /> General—User Defined /\ n <br /> *within o-�s-�30.00 �i(�J �J���.x-�-- r o ,�3 , �3 <br /> I herby apply for a User Defined Permit and I aclrnowledge 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 pernut and work is not to start without a pernvt;and that the work <br /> vyi}t e m ccordance wi h t approved plan. <br /> � , � <br /> _ ����.� , <br /> -'.�:� ,.�'c.�_���� l� � ,� <br /> ��icant � Date <br /> �ia D��aea P.am�'�,� <br />