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1+ , 0���,� City of Orono FQR CITY BSE C1NLY <br /> P.O.Box 66 13ate Receiv�l: Perntit# <br /> : 2750 Kelley Pazkway <br /> � t � Crystal Bay,MN 55323 <br /> x � (952)249-4600 Amount: $ C.U.P Filed: <br /> v <br /> Approved By: Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO-USER DEFINED/GENERAL PERNIIT <br /> (All permits must be approved by the Building Official and/or Zoning Depariment) <br /> JO��1���}WriOP�OI1Xl�l{}31: <br /> Site Address: ,3��0 ��+�� � �,a,v� <br /> Owner: `�r�P�u�;� ��1��� Mailing Address: 3 a7�o ,�n�,�,�,` ��- <br /> City: C�/L�.�� Zip: <br /> Home Phone: Alternate Phone: <br /> �c�ntractc�r/Appiicant Lnformation: <br /> Contractor/App.: �Y1��1��� 1�-,�a',��,. I�,, Contact Person: d�I�c ..l �/-� <br /> Address: C'�'r`-i� flcw�c � State License#: � (�'� <br /> City: Zip: _,.,��� Expiration Date: 3J3>�o� <br /> Phone: q 5 Z- �'!`7 S-�i 35' �i Alternate Phone: �l�'L— ��2— 2 , 4 3 <br /> TYPES.OF U�ER DEFINET!PERTVIITS r <br /> ❑ Stairwav to Lake ❑ Retainin Walls ❑ Temnorary Trailer <br /> General—User Defined Surcharge General—User Defined Surctiarge General—User Defined <br /> *(Per UBC� *(Per UBC� *$30.00 <br /> *Estimated Cost:$ �Estimated Cost:$ <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> '�Estimated Cost:$ $50.00(Needs Site Plan) <br /> General-User Defined �501+Cubic Yazds <br /> ❑ Residential- $30.00 $50.00(1Jeeds 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 work is not to start without a permit; and that the <br /> work will be in accordance with the approved plan. <br /> ,����� `���7�, <br /> Applicant Date <br /> R£S@t F�� �n0f,a��asnaroa <br />