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, , � , �v��� �� <br /> , � � 1�� F�O;R� CITY USE ONLY�/( � <br /> - City of Orono 5 Z?j( DateReceived:�-t,�"f"`*" Permit#�(�/1 ( bC!J <br /> N <br /> �'��O P.O.Box 66 <br /> _ � ��1 <br /> , ,,._ , 2750 Kelley Parkway �� ,�-� <br /> �,� '�•t��` t��,� Crystal Bay,MN 55323 C.UP Filed: <br /> Amount: � � <br /> ?�, �U�Y,�y.o�/i (952)249-4600 � <br /> ��'+�°4�� APProved By: - . l ��i�y"„ Site Plan: <br /> Recommends: A roval <br /> Denial ❑ <br /> CITY OF ORONO-USER DEFIN�ED/GENERAL P�E�RMIT � <br /> (All permits must be approved by the B g <br /> Job Site/Owner Information: <br /> Site Address: 1640 Bohns Point Road <br /> Scott Ross Mailing Address: <br /> 8609 Harriet Ave S. <br /> Qwner: 55420 <br /> Bloomington Zip: <br /> City: (g�2) 805-5075 <br /> Alternate Phone: <br /> Home Phone: <br /> �Contractor/Applicant Information: <br /> Yardscapes Inc. Contact Person: <br /> Lincoln Or Dave <br /> Contractor/App.: <br /> XXXXXXXXXXXXX <br /> 8609 Harriet Ave S. State License#: <br /> Address: <br /> Bloominton 55420 Expiration Date: <br /> City: Zlp� f,12.363.5789 <br /> �95�)gg7-2794 Alternate Phone: <br /> Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> � TemAorarv Trailer <br /> � t0 Lake � jZet811ll1]�T Wa11S General—UserDefined <br /> S��av General—User Defined Swcharge *$30.00 <br /> General—User Defined Surcharge *�per UBC) <br /> * (Per UBC) *Estimated Cost: $ �6����'° <br /> *Estimated Cost: $_— � <br /> Zonin¢Review <br /> � I,arid[1]t0T3t10T1 General—User Defincd <br /> [] Docks–42"OT'GTeater (}eneral—User Defined *For 0-75'Zone-$30.00 <br /> General—User Defined Surchar�e � Q-500 CubiC Yards <br /> ❑ Commercial–(Per UBC) �50.00(1�'eeas s]te Plan) <br /> *Estimated Cost:$ � 501+Cubic Yards <br /> Genera]—User Defined $50.��(�eeds GU.P.) <br /> �] Residential- $30.00 <br /> � Tree�al <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> I herb apply for a User Defined Permit and I acknowlT�nances and Codes of the C ty and wi h he Sta e <br /> Y <br /> accurate;that the work will be in conformance with the <br /> Building Code;that I understand this is not a permit and wark is not to start without a permit, and that the <br /> work will be in accordance wi the approved plan. <br /> 05/12/06 <br /> - Date �S����a p�,,,;t sna�oa� <br /> ppplicant Reset Form <br />