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City of Orono FO�SE ONLY <br /> ' P.O.Box 66 Date Received: Permit# p?00�'f-'aQp��g <br /> 2750 Kelley Parkway <br /> � Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ C.U.P Filed: � <br /> Appro ed Site Plan: C%� <br /> :tZ .0, <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Otl"icial and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: l�� ^ c ���� <br /> Owner: �� � Mailing Address: C`s�� ��e�'�� ���'�`'��"I <br /> City: ���7"P� Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.:��`�� Contact Person: �� <br /> Address: ���� �� �L. l� State License#: <br /> City: � Zip: ��`.�' Expiration Date: <br /> Phone: ���--�c����—Q� Alternate Phone: ��� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake �RetaininQ Walls ❑ Temporary Trailer <br /> General-User Uefined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) *(Per UBC) �� ��' *$30.00 <br /> *Estimated Cost: $ * Estimated Cost: $�_ <br /> ❑ Docks-One Time(rron-Lake Mcka� ❑ Land Alteration ❑ Zonin�Review <br /> General-User Defined Surchazge 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 /> Generai-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs 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 ofthe 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 acco�da��with the approved plan. <br /> S ��-d� <br /> A p� Date <br /> / Reset Form <br /> (User Defined Permit 05/08/09) <br />