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� �,��� City of Orono FOR CITY USE ONLY � / <br /> 0�� P.O.Box 66 D� Date Received. >:•�=) Permit# �( � L� t <br /> j s� 1 2750 F:elley Parh�vay ��,�� t: I <br /> `� ��1j ��;�-- �� Crystal Bay,MN 55323 �y/ 2 <br /> ��' ��,�v�,�, (952)249-4600 Amount: 5��/ /•(O� C.U.P Filed: <br /> ��rc�a.;,s�i <br /> \� �„qy <br /> Appro�vyed By � Site Plan: <br /> (�l <br /> Recommends: A roval /[]� Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERl�ZIT nd � I��''��r-� <br /> (All pennits must be zpproved by the Building Official and/or Zoning Department) J�G fi'¢,�.S � ���►4�oop�, <br /> C.a(1 �C/ si/f�i,n�2 <br /> Job Site/Owner Iiiformation: � (O hri►, /nS�ee�il�t <br /> },�.[�u� bw�/'ng cv,4/(. <br /> t. � "��' �' � � <br /> S ite Address: � Y�l-L�I� C�c.c�UC.� e��--`i�-C� �S�J� <br /> Owner: 1� + ���5 Mailin; Address: c1�.PC.� �Y�(,�J�1- �C�-Gl' l� <br /> c�ty: (�� (,c�l��- z�p: 5S3SZp <br /> Home Phone: �S� � ��'� `7� Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A �'��S�CY� �1��'� `��+-���I''C=ontact Person: � �'-+Z <br /> �•. <br /> PP.: <br /> Address: 'tf�S lA�i�!lS�� fSOG�I�" State License #: o�GUd��FSaI S <br /> City: T"��- Zip: h53�� Expiration Date: � �/ �� <br /> Phone: ����"��c�S. r� Alternate Phone: � !a- �'J �7�% -�Q <br /> TYPES OF US�R DEFINED PERMITS <br /> ❑ Stairwav to Lake �Retainin� Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge �� Generai—User De ined 3urcharge General—User Defined <br /> * (Per UBC) * (Per UBC) �L '��30.00 <br /> *Estimated Cost: � *Estimated Cost: $ J� � ` <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ ZoninQ 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 /> * Estimated Cost: $ �SO.00(Needs Sire Plan) <br /> General—UserDefined ❑ 501-CubiC�`ards <br /> ❑ Residential - �30.00 �50.00(Needs C.li.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * W ithin 0-75' -�30.00 <br /> I herb�� apply for a User Defined Permit and I acl:no���ledtre that the information above is comp(etz and <br /> accurate;that the work will be in conformance�vith the Ordinances and Codes of the Citv and with the State <br /> Building de; that I understa d this is not a penr�it and ���ork is not to start ��,�ithout a permit; and that the <br /> �i�ork w' b in accor a c ��,' tne appro��ed plan. <br /> � / v <br /> Applic t _ .. � Da <br /> Reset Form c�s:,o_F::,_z���,��;��,��� <br />