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1� <br /> r , � ,��� City of Orono FOR CITY USE ONLY � � <br /> P.O.Box 66 Date Received: `� `[. t � "'�Permit# ;,.�,'� L:� `�="' � I <br /> ��;,�,,,�, � 2750 Kelley Parktivay r' / �J/,, <br /> � 71J�'�r�. ` Crystal Bay,MN 55323 Amount: $�7 Cp9, /"c.U.P Filed: <br /> `�t����1��'c° (952)249-4600 �,n� b� <br /> �8Ap6 � oI ��Approve d By:����Site Plan: <br /> � 1 I� Recommends: A roval �[ Denial ❑ <br /> 0^�� FiNA� I N.S�O �'���� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pemiits must be approved by the Building Official and/or Zoning Department) <br /> Job Site l Owner`I�iforniation: <br /> Site Address: 7�U ��;^�'T 1� �a r��-� r.� JZ � <br /> Owner: ��1n� S��q-l� J,� Mailin�Address: ��� ���-� 13!'0,�^� 2� <br /> City: ��I�v Zip: .�53s'6 <br /> Home Phone: Alteinate Phone: ���� ' (�a5� �� <br /> `Contractor/ Applicant Information: <br /> Contractor/App.:�r,� ,� N�c�'�-[� �.,�,,"e,� Contact Person: � 1 r✓i <br /> Address: �J�� 17A��'A- ��� State License#: <br /> City: �.+�-�'�. Zip: ���6 E�piration Date: <br /> Phone: �(a"�6�-- ��-/�� Alternate Phone: '�/��- �CX%� �7'y� <br /> ` `TYPES OF USER DEFINED PERMITS <br /> �tairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ ' (� Oc�� *Estimated Cost: $ <br /> ❑ Docks-42" or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-�00 Cubic Yards *ForO-75'Zone-�30.00 <br /> *Estimated Cost: � $50.00 (Needs Site Ptan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $SO.00 (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 acl:nowledge 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 perniit and work is not to start without a pemut;and that the work <br /> will be in acc_rdance with the approved plan. <br /> �� <br /> � �� � � <br /> Applicant Date <br /> Rlsa Defined Permit 3/18l041 <br />