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¢�� City of Orono �� FOR CITY USE ONLY <br /> P.O.Box 66 1•�� Date Received: � f Q(i Permit# �D <br /> O, O , 1 /--� �} `�'(�9 <br /> � �, �I 2750 Kelley Parkway � `L,/ <br /> a '1"� z'�`}. � Gystal Bay,MN 55323 Amount: $ TY5"`j� C.U.P Filed: <br /> ��' �''�n�,�gy,�` (952)249-4(00 <br /> �r��o <br /> Approved By: C T"r (�d. Site Plan: �2•��/-db <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pemiits must be approved by the Building Official and/or Zoning Departme�t) <br /> Job Site/Owner Tnformation: <br /> Site Address: J� `r � �--�--5"� � ✓ C . � '� <br /> ---� _� _— <br /> Owner: ��'2;> L• �j� z�nS'v�-�. Mailing Address: c%l�—��--s`=� <br /> City: ��_�z�.��� zip: ��' 3'� % <br /> Home Phone: _7�'��� �,��/ �7� -�� Alternate Phone: ;�J.� �/�1'�,��_� j <br /> Contractor/Applicant Information: j <br /> __--�, i � <br /> Contractor/App.: �' �"�i�/� y �,�,��.,�a��i-- Contact Person: ���;�,���— <br /> Address: ;Sv�/v ° ��� State License #: <br /> City: 1-c.�� � r.. Zip:_�.� -��/ Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake t[�etaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) _�,' *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $��;�U <br /> ❑ Docks-42"or Greater [�Land Alteration ❑ Zoning Review <br /> Genera]—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) �0-500 Cubic Yards *For 0-75'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 herUy apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate; that the work will be � confo nce with the Ordinances and Codes of the City and with the State <br /> Building Code;that erstan s is ot a permit and work is not to start without a pernut;and that the wark <br /> will ord wit app�6ved . <br /> _ _„� <br /> _ - ..-- <br /> _-_ <br /> ____ .. _ J� - r ?�� U � <br /> � <br /> Applic t � Date <br /> � (Usa DeSned Pefnrit 3/18/Q4) <br />