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e , <br /> ,¢�� City of Orono FOR CITY USE ONLY <br /> ,,-� <br /> P.O.Box 66 Date Received ;'� �"� i Pern�it# e� l "`)(��' <br /> ��,� � 2750 Kelley Parkway j <br /> ag'�,���`��� Crystal Bay,MN 55323 Amount: $ •��ti.' ` " C.U.P Filed: ���� �� <br /> �,'�("��r��,`��,�� (952)249-4600 � � �� <br /> ����� Approved By: Site Vlan: j'U'r`7 ` <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must Ue approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: G��� ����5 ��- ��` <br /> Owner: � � Mailing Address: <br /> City: Zip: <br /> Hame Phone: ( ) Alternate Phone: ( ) <br /> Contraetar/Applicant Information: <br /> Contractar/App.:�y�� Contact Person: �—�-l.trGL �LD(� <br /> Address: �J'���J ��'Y�%G�cNI � State License #: <br /> City: l� � l5 Zip: �'J�� Expiration Date: <br /> Phone: ((,�L Z ) �CQ I 9) CJ t� Alternate Phone: (�f Z ) CQ 1� �j 3� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retaimn 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 �Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge ('e ral—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) �0-500' -$50.00(tveeds s�te Plan) *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ ❑ 501' +-$50.00(Needs C.U.P.) <br /> General—User Defined <br /> ❑ Residential- $30.00 � <br /> ^- � �K� �V''i"' (�,�5 ����� �� ��� �� n <br /> ❑ Tree Removal � � _ _ � <br /> General—User Defined � , 1 1 � I �� <br /> *Within 0-75' -$30.00 "— �� WC�C�! " 1°'���-t� � �l '� '���iV�Q'C�Dc� <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the wark 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 wark is not to start without a permit;and that the work <br /> will be in acc e approved plan. <br /> , 1-�1� <br /> Ap ican Dat <br /> ��` � �� O �{^ tuseroeSneaEembe—siidio3> <br /> �J� �l <br />