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g0� City of Orono F CIT U5E ONLY � a� P.O.Box 66 Date Received: / � �f Permit#��' ��,, � 2750 Kelley Parkway a tt��.�''�> ,� Crystal Bay,MN 55323 Amount: $��5 C.U.P Filed: �d 'P?��xi�}$,o` (952)249-4600 ��KO$ Approved By:�f�C Site Plan: Recommends: A roval � Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT (All permits must be approved by the Building Official and/or Zoning Department) Job Site/Owner Infarmation: Site Address: � ?l� ��'� �� v Owner: �/� ��LS Mailing Address: c�ty: ��oNO z�p: Home Phone: Alternate Phone: ��,�- �7^ �S��D� Contractor/Applicant Information: � Contractor/App.:�� Contact Person: ��iQ� ��/�" �� Address: �P�� l4 ` �• /(� State License#: City: V��i�� Zip: �3�3 Expiration Date: Phone: 7�03` ��7-��.3� Alternate Phone: �� FSO��GY�� T'Y'PE� OF USER DEFINED PERMITS ', �Stairway to Lake �,- �'"� � -M. . Retaining Walls ❑ Temporary Trailer General—User Defined�S�urcharge t General—User Defined Surcharge General—User Defined *(Per UBC) f �7 * (Per UBC) *$30.00 *Estimated ost: $�� —" . *Estimated Cost: $ � ❑ Docks—One Time on—Lake Mtka ❑ Land Alteration ❑ Zoning Review General—User Defined Surcharge General—User Detined General—User Defined ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *For 0-75 Zone-$30.00 * Estimated Cost: $ $50.00(Needs Site Plan) General-User Detined ❑ 501+CubiC Yards ❑ Residential- $30.00 $SO.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; th t work will be in conformance with the Ordinances and Codes of the City and with the State Building C that I understand this is not a permit and work is not to start without a permit;and that the work will be i i c rdance with the approved plan. __ - ' - ---_ �"-��oGl Applican Date tus��s�ea re�t as�osro��