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f . . , �� 1 t'�� ��� � � <br /> , ' ,4�� City of Orono FOR C[TY USE ONLY ��O <br /> O y` Q P.O.Box 66 Date Received: �3p�0� Permit# Zvv-� - <br /> �,,1 2750 Kelley Parkway <br /> � ,11���t�r- � Crystal Bay,MN 55323 Amount: $l/S�� C.U.P Filed: <br /> ��`��y� (952)249-4600 <br /> $ Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> ZooR-ooc� -�Pt�n nev►ew r-eQ. �3��3g <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT � b� ��t�� <br /> (All permits must be approved by the Building Official and/or Zoning Department) a,'�•Qq <br /> Job Site/Owner Inforrnatian: ;;��m�,� „� �.: <br /> , L <br /> Site Address: �1 E '� �--f�S CQ �i/ /V')� �� <br /> �'F�c� ��a�r(o�v� S��erv�v �� �c� ,�. <br /> Owner: � I V(� Mailing Address: �q�O � � `� fi ���� <br /> City: �� 1^�R l� Zip: � �.�� <br /> C.('/� <br /> Home Phone: ���=�" ���/� �"���� Alternate Phone: ���, �,��� � (� �� <br /> Contractor/Applicant Information: �� � � �� <br /> Contractor/App.: �'��� Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> �Stairway to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) � * (Per UBC) *$30.00 <br /> *Estimated Co t: ��J -C�7 *Estimated Cost: $ <br /> �=-�.ic f uC1P C��'%�c�"�� — ;'i�Q.CJC $I,000 <br /> ❑ Docks-One Time�No�-Lake Mcka) ❑ Land Alteration ❑ Zoning Review <br /> General—User Detined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *EStlmated CoSt: $ $50.00(Needs Site Plan) <br /> General-User Detined ❑ 501+CublC YaTds <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 wark is not to start without a permit;and that the wark <br /> will be in acco�arice"vvith-the-a��x.c�ved plan. <br /> � _.. <br /> - , _,.�-- �,. � ' � G <br /> � ,,w� <br /> Ap�J,ic % Date <br /> 1 n,E'-t/�r�� �7 f 3�l �� 6��.�t�t�!os} <br /> � <br /> G�f�'�✓`�t c <br />