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,¢0� City of Orono � � s^� FO�ITY USE ONLY <br /> O s O P.O.Box 66 ����y'�;��/ Date Received: ,�— �� Permit# <br /> ,�,,;��,,,. 2750 Kelley Parkway <br /> � 'U��;�'� ti CrysCal Bay,MN 55323 �� �� - Amount: $��°�� C.U.P Fi1ed: <br /> • �'��r��r���,�` �9sz�2a9-46o0 , � 1 c.`� � ` � <br /> �Kpe Approved By: �.V � Site Plan: t/ <br /> �,'r���'�✓`f��✓�(.� ,�..,/ <br /> Recommends: A roval c� Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pe�n�its must Ue approved by the Building Official and/or Zoning Department) <br /> c G'� "�(1 r <br /> Job Site/Owner Infornlation: Cm�� � f �f � �I`�G� <br /> j �\�c,� �� S��eC��an. <br /> Site Address: 1 UU ��� �,,.�s� <br /> Owner: 1� i��n�,�` J ��n�Sc��• Mailing Address: ipp L.�e�., ��s`. <br /> City: � `�.,,a Zip: � � �� 553`�( <br /> Home Phone: �l'�7_ Z�� `� ,� z Alternate Phone: ��(Z� �o L'�5 3(a ��,1� <br /> Contractor/Applicant Inforniation: <br /> Contractor/App.: -�o�,�� � Jv..� Contact Person: ��oe'_ <br /> Address: �� l�x 10 5`� State License #: <br /> City: ��,`,,��_aT�� V�N, Zip: S53�}"1 EYpiration Date: <br /> Phone: "��Z '��kS l�-�Z i1 Alternate Phone: �uuk �'�2 ��t�-�;�-'-�o <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav 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 Cost: $ *Estimated Cost: $ <br /> ❑ Docks-42" or Greater Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge Gener 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 herby apply for a User Defined Permit and I aclrnowledge 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 /> V�,'��Q� � _� _ ����a� <br /> Applicant Date <br /> (User�De6ned PeRnit 3/18/Q„4) <br />