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o,�p�o City of Orono FO ci Y usE orrLY ���,�� <br /> P.O.Box 66 Date Received:/ fl Pennit#�_ <br /> �yt�„ 2750 Kelley Parkway <br /> , � i��zi:� F Crystal Bay,MN�5323 Amount: $ '�� C.U.P Filed: <br /> �'t��'F'}r��'�°` (952)249-4600 � <br /> ��BKO� Approved By: Site Plani �_ <br /> Recommends: A roval � Denial ❑ <br /> CuP/v���►�.. o�� 332.3 <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All perniits must Ue approved by the Building Official and/or Zoning Departmen[) <br /> Job Site/Owner I�iforniation: <br /> Site Address: 2�� L�(4-�5 ��1� <br /> Owner: �f Cr�c� ��,�7/'J�/f-f Mailing Address: Z(v�3 CG��S�c(¢,�: <br /> City: (,�ir14 �A�.. Zip: ..��35�_ <br /> Home Phone: Alternate Phone: <br /> Connactor/Applicant Information: <br /> Contractor/App.: �1'uG�1ir'CS Un�Im��d,.Zhcr. Contact Person: �OSS �.Ah 9��� <br /> Address: J��"�2 S C�I�/tt�7 � State License#: Z 017 �39,[•�_ <br /> City: �g�h Zip: .�S357 ExpirationDate: <br /> Phone: �v� "3�4'' ��o�03 Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake [�Retainin�Walls ❑ Tem}:,orary Trailer <br /> General—User Defined Surchar�e General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * �30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ g,b�p 60 <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General—User Defined Sw charge General—User Defined General—User Defined <br /> ❑ Corrullercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7�'Zone-�30.00 <br /> * Estimated Cost: $ $50.00 (Needs Site Plan) <br /> General—User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- �30.00 $50.00 (t�eeds C.u.P.) <br /> ❑ Tree Removal <br /> General—User Defined � <br /> *Within 0-75' - $30.00 <br /> I herby app y for a User efined Permit and I acicnowledae that the infonnation aUove is complete and <br /> accurate; that the work 1 be in conformance with the Ordinances and Codes of the City and with the State <br /> Buildin��Code;that I u derstand this is not a permit and work is not to start without a permit;and that the work <br /> _ _ <br /> will be:in accordan�'e � rove pIan.�' ,, <br /> � � <br /> A ' nt Date <br /> i���P,n..F..>.�o....,;�iii cinni <br />