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,r�(��� City of Orono F R I Y U,$E ONLY <br /> /O�' �r�, P.O.Box 66 Date Received: Q� Permit# <br /> � a� 2750 Kelley Parkway <br /> ,� 3�i�y��}- ��� Crystal Bay,MN 55323 <br /> + .t�r�V�i�/ (952)249-4600 Amount: $ C U P Filed <br /> �r�°�.� <br /> Approved By: __(.� Site Plan:��J <br /> T <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> � (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/ Owner Information: ' <br /> � � <br /> Site Address: 7 � <br /> Owner: c /% e� f Mailing Address: �,?�/ ('j � �j�vt1��v/ <br /> City: �7 r� v r'1 � Zip: � <br /> Home Phone: Alternate Phone: � � 2 -��� � ��� <br /> Contractor/Applicanf Information: <br /> Contractor/App.: J�'4`�L f�7' /�'���5 Contact Person: s� /s� <br /> Address: �3�a j'ds� �-�ti'L-- State License #: <br /> City: G- /i� � . Zip: �S��3� Expiration Date: <br /> Phone: �.3�-2 — ��/� —.3,� !� Alternate Phone: y"7y .-�;,Zy►� <br /> TYPES OF US�R DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retainin�Walls ❑ Temporary 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 0 Land Alteration ��fj�� �l�. ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined�� � y General—User Defi�ed <br /> ❑ Commercial—(Per UBC) �' 0-500 Cubic Yards 11���C� *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) L� � <br /> General—User Defined ❑ 501+CublC YaCds <br /> ❑ Residentia]- �30.00 $50.00(Needs C.U.P.) <br /> � � <br /> ❑ Tree Removal � � W �,''�1�� �U �C(��C�/'r�1 �,}�C�� l C� (�Ol IQ�� <br /> General—User Defined <br /> * Within 0-75' -$30.00 <br /> �U �C,� N` C 1����� � P C�✓� C I� � �'�,l ���� <br /> cr v� \`�, � �,�,� <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 <br /> work will be in accordance with the approved plan. <br /> � , , <br /> ��- ���� .� � � ;�-��-- l/��/�/i D.r� <br /> Applic t <br /> }, Date � <br /> �,;�� R��set Form� '�s �u�ner�ea�«�c3i�sroaj <br /> o� <br /> ,�:�����°� ���.����,��;-� <br />