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� . <br /> ' � ` ��� City of Orono FOR�I�ONLY <br /> � Q P.O.Box 66 Date Received: � ermit#p�0(��_ �� <br /> �1 2750 Kelley Parkway <br /> � ���t�;�> � Crystal Bay,MN 55323 Amount: $ �J'd.� C.U.P Filed: <br /> �' "��„r�?��y�` (952)249-4600 �� � <br /> ��KO$ Approved By: •r� U • Site Plan: <br /> � <br /> Recommends: A roval Deniat ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the f3uilding Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: � �"/ � 3 � u St� e o/n f �.o � � <br /> Owner: �/t� �ti �a r i.,w r // Mailing Address: �� ,5�,�f'l� —1;� S�. <br /> $ J: 'fc zlSv� <br /> City: /�.�,�� �� �� f,`3 Zip: S S �oZ <br /> ��j _ �t"�v1 C c���A � �c5� t���on i /c7 f� <br /> Home Phone: l� / Z 9� `/ / s� / 3 Alternate Phone: �1 S"z �/3 S� Iv/G <br /> Contractor�/Applicant InformaCion: � <br /> Contractor/App.: ,��vl t c �t,w � c �r.� Contact Person: �a r X �� ��- ��r <br /> l y s z 5" /�,'� h �-4 y � <br /> Address: S�.-�!-� i v y State License#: /�/,q <br /> City: �'1�`�� t �v n/�u Zip: �s 3 y S�� Expiration Date: il//� <br /> Phone: q �� �% 3 S� /vlv Alternate Phone: � -,�°' Z � � y 3 7�/� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retainin�Walls ❑ Temporary Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Detined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—One Time(rron-�ke M�ka) �Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge e ral-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 /> Gencral—User Detined ❑ 501+CUb1C Y1T'C1S <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 /> Building Code;that I understand this is not a permit and work is not to start without a permit;and that the work <br /> will be in accordance with the approved plan. <br /> ����! �� _ � - z � _ �= � <br /> , �... <br /> Applicant Date <br /> (Uea Ae6ried Peccmt OS/08/09) <br />