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. , ,��� City of Orono �i�� FOR CITY USE ONLY <br /> O 0 P.O.Box 66 Date Received: -h-�7 Pennit#Jg//��'� <br /> + �,"��,�, 2750 Kelley Parkway �b l <br /> � � ij�`��.�. F Crystal Bay,MN 55323 �[ i� Amount: $ 33�.ZJ C.U.P Filed: <br /> 6 �l-:1�;. ti <br /> � �'�,'?+��'r{��,� (952)249-4600 � <br /> �$e�O� ApUroved By: L-�• <br /> Site Platt: <br /> Recommends: A roval,� Denial ❑ <br /> �EGEIV�'�� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT ��� � 3 2007 <br /> (All perniits must Ue approved Uy the Building OTficial and/or Zoning Department) <br /> �'ITY �F �����_, <br /> Job Site/Owner I�iforniation: `y <br /> Site Address: �� 1 C,?5 L� � 1 � ���?�� <br /> Owner: 1'C�� ��yJl O�� Mailing Address: ���i' <br /> c�ty: '� - ��,� �n z�p: S S"� �� � <br /> Home Phone: Alternate Phone: <br /> Conhactor/Applicant Information: <br /> � � <br /> Contractor/App.: ���(1 \ ?l:� -�-'''�'' Contact Person: � �S-(, `�' <br /> , <br /> Address: ����I � �t'�l/Y1 �p� - "rState License #: � , <br /> City: ? � Zip: S`S��`� Expiration Date: <br /> � <br /> . �Phone: � S�_�y1� ' 7��� Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake 0 R tainin Walls ❑ Temporary Trailer <br /> General—User Defined Surdlarge General—User Defined Surcharee General—User Defined <br /> * (Per UBC) * (Per UBC) J * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ ��, J `� <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Corrunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7�'Zone-$30.00 <br /> * Estimated Cost: � $50.00 (Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 �50.00 (1�leeds C.u.P.) <br /> ❑ Tree Removal <br /> General—User De6ned <br /> * Within 0-75' - �30.00 <br /> I herby apply for a User Defined Permit and I acicnowled�e that the infonnation aUove 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 /> Building Code;that I understand this is not a permit and work is not to start without a pern�it;and that the work <br /> will be in accordance «�ith the a roved plan. <br /> --� <br /> � ��1 � <br /> Applicant Date <br /> 'rt<<...n.e�..+v....,;�vi crna� <br />