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¢0 j�-�� City of Orono FOR CTTY USE ONLY <br /> O. `rO�` P.O.Box 66 Date Received: � �—� �� � � Permit# -�I,,� %;- J'_' <br /> ti;,; � 2750 Kelley Parkway Z77—'7�' � <br /> � �' , Crystal Bay,MN 55323 <br /> �+'���.xato�i (952)249-4600 <br /> Amount: $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT <br /> (All penniu must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: U� I �W� ��� '`��.TV' , DI�1�� <br /> Owner: MAI��� l,.rU'I.S �VI w a�CZIMQ�I� Mailing Address: Z�D UnG�A INOd�1 �-l1� <br /> ay� M �-��� <br /> c��y: z�p: <br /> Home Phone: `�I�2' �1�•� i�� Alternate Phone: <br /> Contractor/Applicant Information: ��0� �'�� <br /> Contractor/App.: �le NG�1I?i b�?1U� Contact Person: �y ���1�1 m <br /> Address: � w 'V � S� Sl�l��� State License#: <br /> City: IV I �S Zip: �'1�� Expiration Date: <br /> Phone: �I� ��'� �`�� Alternate Phone: �vIZ• I I�•�� I - SCQ I� <br /> TYPES OF USER DEFINED PERNIITS <br /> ❑ Stairwav to Lake � Retaining W�lls ❑ Temporarv 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 /> VM V a� f—� Docks-42"or Greater � Land Alteration ❑ Zoning Review <br /> 1nA�W i w �,� General—User Defined Surcharge General—User Defined General—User Defined <br /> �V�� F� ❑ Commercial-(Per UBC) '� 0-500 Cubic Yards *Fora75'Zone-$30.00 <br /> Mln�. �K *Est(mated Cost: $ $50.00(Needs Site Plan) <br /> Wa�ersl�ud General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs c.U.P.) <br /> ��SJ"�� e ova <br /> �� I,�l�• e eral U er fine <br /> iPi * � �n ° -$ o 0 <br /> ��� n���L �u�-�c�, n o -�S <br /> ���r�k�� I 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 unders this is not a permit and work is not to start without a permit; and that the <br /> w 'll be in a c r e ith the approved plan. <br /> '�_ (�.�-05 <br /> ica t Date <br /> Reset Form N��'°`dpa'°"'"�,°" <br />