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~ �,¢�� City of Orono FOR CITY USE ONLY / <br /> � �� P.O.Bo�66 �� Permit# �( { ����.l <br /> h� <br /> 2750 Kelley Parkway Date Received: � <br /> � �Ih j�'�, k Crystal Bay,MN 55323 <br /> •s� 1 �-t��i �` <br /> ���"`.�t�',��y�, (952)249-4600 Amount: $ C.U.P Filed: <br /> satio�` <br /> Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pennits must bc approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Infonnation: <br /> Site Address: 1�t,C�lr1 (�C.�LX� �C� �j�aj� <br /> Owner: ���c .f- , ` G :.�1 t�l �ZKS Mailin� Address: Ct�D(� �!'�1��t.�i'7 �U��Ck' l� <br /> City: 11.)VL� ����-- Zip: ���3�(p <br /> Home Phone: �S�-1 �CJ��` �a`� � Alternate Phone: <br /> Contractor/Applicant Information: � <br /> a � J � <br /> Contractor/App.:�C15�/��, ��Qf3�f`�'�t.l✓�� ontact Person: `��, F'��'- Z <br /> Address; � r IS1�Z')� �G<li+" <br /> `Z"U�g � �! (� State License #: �2 CiO�� FS�I S' <br /> City: /"6T��- Zip: �S��S Expiration Date: � � f�/� <br /> Phone: �5�l/�'-(��"S�j'�5�� Alte�rnate Phone: � t�- j�7 -`7fo� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake [�Retaining Walls ❑ Temporar� Trailer <br /> General—User Defined Surcharge �� General—User Deiined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: $ *Estimated Cost: � � ;�' <br /> ❑ Docl�s—42" or Greater ❑ Land Alteration ❑ ZoninQ Review <br /> General—User Defined Surcharee Generai—User Defined Gencral�Use;Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> '� Estimated Cost: � �50.00(Needs Si�e P�an) <br /> General—UserDefined ❑ SO1rCubICYa[ds <br /> ❑ Residential - �30.00 �50.00(Needs C.li.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * «�ithin 0-75' -�30.00 <br /> I herby appl}� for a User Defined Permit and I acl:no���ledge that the information above is complete and <br /> accurate:that the work wil] be in conformance�vith the Ordinances and Codes of the Citv and with the State <br /> BuildinQ de; that I understa d this is not a pennit and ���ork is not to start ���ithout a permit; and that the <br /> work �v� b in accor a c ��' the appro`�ed plan. <br /> � �'� / ��', <br /> Applic nt __. � Dat <br /> Reset Form (usarDennecPcicni;;;l'LrOai <br />