2010-00395 (land alteration) - Laserfiche WebLink

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�� City of Orono FOR CITY USE ONLY , � � P.O.Box 66 Date Received: S��[DPermit# �� � ` 2750 Kelley Parkway a �'j � �''�r � �''� �+ Crystal Bay,MN 55323 Amount: $ C.U.P Filed: �� j�y�y�� (952)249-4600 /� �Yseso� �� Approved By: Site Plan: Recommends: A ro a Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT (All permits must be approved by the Building Official and/or Zoning Department) 'Job Site/Owner Information: ` Site Address: � l� �� 5s,$�� Owner: �e��-s�� Mailing Address: �� ( � S�� c�ty: ��r��a z�p: ��`� � Home Phone: _��Z' .�/_�-- �71f� Alternate Phone: �� C'� S7�- �}�� Contractor/Applicant Inforrr�ation: �� ,,�,;, : Contractor/App.: �� c:c..peS �-'�_ Contact Person: . � -� Address: Z3Y.�� L..�,,,,;�lS _�� State License #: `�c��'�(� �� City: � � Zip: ��3�� Expiration Date: � �� 1l Phone: ��Z� �Z.�p� �'�'r�% Alternate Phone: 7�.�' Z�C�- 2_C��`� � _ ',�"x,��'��,`OP��[I`� +.�R�D��NED PERMITS ;. � s � �� '�� ;� ; . � � � � �: ❑ Stairway to Lake ❑ Retainin�Walls ❑ Tempararv Trailer General—User Defined Surcharge General—User Defined Surcharge General—User Defined * (Per UBC) * (Per UBC) * $30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks-One Time(t�o„-t�ke Mcka) �Land Alteration ❑ Zonin�Review General—User Defined Surcharge General—User Defined General—User Defined ❑ Commercial-(Per UBC) �0-500 Cubic Yards *ForO-75'Zone-$30.00 *Estimated Cost: $ $50.00(Needs Site Plan) General—Uscr Defined ❑ 501+CubiC Yards ❑ Residential- $30.00 $50.00(Needs C.U.P.) ❑ Tree Removal General—User Defined *Within 0-75' -$30.00 I herby apply for a User Defined Permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code;that I understand this is not a permit and work is not to start without a permit;and that the work will be in ' h the approved plan. - � g' /e Applicant Date (User Defiried Pem�rit OSfQ&/49}