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f � � <br /> �,�Q� City of Orono ROR CITY USE ONLY <br /> �` P.O.Box 66 Date Received: !. _ � �';�Permit <br /> �c��, ... �`1 2750 Kefley Parl.�vay <br /> +' ' �� ��I y�,c,�•. � Cryscal Bay,MN 55323 Bp _ <br /> ��' �i� �v�,�� (952)249-4600 Amount: $� C.U.P Filed: <br /> �ra"°�` <br /> Approved By: ��K�i T_ Site Plan: <br /> � r.vrc St-d1 <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERI�ZIT <br /> (All pennits must be approved by[he Building Offici2l and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: ��D(� �?j .��'1 �(;C�_Cx � l�Ut�i�i ��� <br /> Owner: ��J � J� 1v7 ��SMailin; Address: Cl(QU �d?�(,t.)/�l � � <br /> c�ty: 1�-�C'2. z�p: 5��� <br /> Home Phone: C �� �v�^ � L Alternate Phone: <br /> Contractor/Applicant Information: <br /> I' '_,� � I� ,{ � � <br /> 1 ,� <br /> Contractor/App.:l�'��i(:�lY�����1V1/•J�ontact Person: � ' ���� <br /> Address; �(;�g W i ��iS�yl �O� State License #: ��(���I���-� <br /> c�ty: �l�K� Zip: �`��y� Expiration Date: �� 3 f () <br /> Phone: �} 5�-� %�� "���� Alternate Phone: �[%��/�t 1�1 —�7�G'� <br /> � <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ RetaininQ Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User De ined Surcharee Genera(—User Defined <br /> * (Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: � <br /> ❑ Docks-42" or Greater �Land Alteration ❑ ZoninQ Review <br /> General—L'ser Defined Suroharge Cien rai—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) �0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ 550.00(Needs Site Planj <br /> General-UserDefined ❑ SOiTCubtCZ'aCds <br /> ❑ Residential - �30.00 �50.00(Needs C.ti.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * \'l'ithin 0-75' -�30.00 <br /> I herby apply for a User Defined Permit and I acl:no���ledQe that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the Cin�and with the State <br /> BuildinQ ode; that I understand this is not a permit and ���ork is not to start ���ithout a permit; and that the <br /> �a�or� �i be in rd .ce� ' ti;e appro`�ed plan. <br /> ��� �7 <br /> �p ica - _ D,.te <br /> Reset Forrn c�S.,D��:,..z�_r,,,C�;�x,���; <br />