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' ,¢p� City of Orono PQR Y LiSE ONLY � <br /> P.O.Box 66 � �Y � <br /> Date Received; ��" �"��' Permit# <br /> � � � 2750 Kelley Parkway ���'��t�` <br /> `a �: ; Crystal Bay,MN 55323 �rO�7'd� ���79 3 <br /> 952 249-4600 Z� C.U.P Filed: <br /> ` ��cs���.°� � ) Amount: $ � <br /> C;�p�t�'"JD� Approved B��: e'f �S�Plan-�ZIP J <br /> � 3�� fi� <br /> ��Q� Recommends: A roval,� Denial ❑ <br /> � <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> .Job Site /Owner Information: <br /> �ite Address: 3275 Carmon Road <br /> (Owner: Mitch Olson Mailing Address: same <br /> �Ci : Orono Zi 55331 <br /> h' P� <br /> lHome Phone: 471-0082 Alternate Phone: <br /> (Contractor/Applicant Information: <br /> �Contractor/App.: Concept Landscaping Contact Person: ��m Smith <br /> ,Address: 3153 Priest Lane State License#: <br /> ��ty: Mound Z�p: 55364 Expiration Date: <br /> IPhone: (952)472-4118 Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> �irway to Lake _ —� 0 Retainin W�alls ❑ Temporary Trailer <br /> General—User Defined Surchazge General—User Defined Surcharge General—User De�ned <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost:$ �`1�oco <br /> � Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User DeYined General—User Defined <br /> ❑ Commercia(—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * EstimAted Cost:$ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P) <br /> � Tree Removal <br /> General—User Defined <br /> * Within 0-75' -$30.00 <br /> !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 /> IBuilding Code;that I understand this is not a permit and work is not to start without a permit; and that the <br /> �work wilk-�accordance with the ap�proved plan. <br /> �__ �' - /� ' /3 -.�av L� <br /> ,Applicant �,� Date <br /> Reset Form (UserDefuredPermit3/18t04) <br />