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��l—� Ci of Orono <br /> ,O�� tY FOR CITY USE ONLY <br /> 0 O�1 P.O.Box 66 Date Received C - �`�Petmit# ���y(,r�l <br /> ( h� 2750 Keiley Parkway <br /> � �y y�,�_�- � Crystal Bay,MN 55323 <br /> ���'t�o�,j (952)249-4600 Amount: $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (Ail pennits must be approved by the Building Official andlor Zoning Department) <br /> 7ob Site/Owner Tirforination: <br /> Site Address: �1�p(� �t?at�u�'1 ��1C� G� � �1'�� ��� <br /> Owner: �i..��� �- S�'ll� �'1 �'���Mailing Address: �(p(j �d'Z7(,L}//L �� /� <br /> c�ty: /��t�► 1.�--�� z�p: 553� <br /> Home )��"' Alternate Phone: <br /> ��JE_ �Ic-�-i�s <br /> Contr S��� ��`�S nation: � <br /> � _I_I_� <br /> Contr � (����1 �u��l� �✓l�) ontact Person: � ' TT����- <br /> ; �( <br /> � — <br /> Addr -�����t�� ��5�1'l 1�0�- State License #: ��i()�c,1���.�" <br /> . <br /> I ..�`� ���- � <br /> City: ��'���'�b�� _ Zip: .r�7� Expiration Date: �c�- 3 t C> <br /> Plzoi '�' `�� I CC / <br /> �� "�� Alternate Phone: (171�--/Q I�1 -�7(�� <br /> ! ��C�-��-- <br /> � ���t`� i�y,.r�� TYPES OF USER DEFINED PERMITS <br /> ` <br /> �� <br /> ❑ � :�/ �C�����,'`? ❑ Retainin�Walls ❑ Temporarv Trailer <br /> !t-' General-User Defined Surcharge General-User DeSned <br /> * (Per UBC) *�30.00 <br /> C�� C�� I� •� * Estimated Cost: � <br /> (�1����-� <br /> ❑ � �Land Alteration ❑ Zonina Review <br /> e GenPral-User Defined General-User Defined <br /> tC) �0-500 Cubic Yards *For 0-75'Zone-�30.00 <br /> * Estimated�;ost: ,n �J0.00(Needs Site Plan) <br /> General-Use-De:ined ❑ SO 1 T CubiC�'aCds <br /> ❑ Residential- �30.00 $50,00(Needs C.li.P.) <br /> ❑ Tree Removal <br /> General-User De�ned <br /> ' \��ithin 0-75' -�30.00 <br /> I herb� apply for a User Defined Permit and I acl:no���ledge that the infonnation above is complete and <br /> accurate;that the work will be in confonnance�vith the Ordinances and Codes of the City and with the State <br /> Buildin� ode; that I understand this is not a permit and work is not to start ���ithout a pennit; and that the <br /> «�or� vi . be in rd ce� ' - tne appro`�ed plan. <br /> �� �7 <br /> Ap ica _ D...te <br /> Reset Form ��s=.D=�:�=zFrm���:iZ�,� <br />