2003-p06694 - land alteration - Laserfiche WebLink

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p City of Orono 'Q�' � FOR C Y USE ONLY P.O.Box 66 �� ,� �(`� � � Date Received: Permit# - � ' � 2750 Kelley Parkway �� :3 '� ��'� ,� � Crystal Bay,MN 55323 '� Amount: $ �� C.U.P Filed: �� R' y� (952)249�600 y,sso$ . Approved By: Site Plan: Recommends: A rov Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT (All permits must be approved by the Building Official and/or Zoning Departrnent) Job�Site t Owner Information: �� '�ti" `��:�' � Site Address: � � l-� ,�,J , Owner: ��/ � ,,.) Gt •�t � � S Mailing Address: �S e� ..... t City: . �/'o•J v Zip: S��,S�' Home Phone: �,�� "-��3' `��j Alternate Phone: �p/�" ��y �f Zf/L �Con�ra�tor/Applicant Information: �� ` � ,� ,. � ��.; Contractor/App.: Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: TYPES OF USER DEFINED PERII7ITS ' ' x 7y,g,3':.t+ � � ❑ Stairwav to Lake ❑ Retainin Walls ❑ Temporary Trailer General—User Defined Surcharge General—User Defined Surcharge Generai—User Defined *(Per UBC) * (Per L'B�) * �30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks-42"or Greater �Land Alteration ❑ Zoning Review General—User Defined Surcharge General—User Defined General—User Defined ❑ Commercia l-(Per UBC) 0-500' -$50.00(tveeds sice Pian) *For 0-75'Zone-$30.00 *Estimated Cost: $ �501' +_$�S.00(Needs C.U.P.) General—User Defined ❑ Residential- $30.00 /�-� �v r ,S'r r,�% ^- �a �/�' q � ❑ Tree Removal � � Genera(—User Defined � , ��`� *Wittun 0-75' -$30.00 ��o�, -�—� ^�O�� j/'�' . I herby apply for a User Defined Permit and I acknowledge that the information above is complete �nd accurate; that the wark will be in conformance with the Ordinances and Codes of the City and with the Sta.t� Building Code;that I understand this is not a pernut and work is not to start without a pernut;and that the work will be in accordan roved plan. _ e� v�- �� Applica Date ��.(�G��/C��____ �''�'�� F--rivaa� �NS� os�� ?e�r:�s"�'..1��"i�7 V"