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¢p� City of Orono �' ' ' <br /> P.O.Box 66 -"� �. ' ° FOR CITY USE ONLY <br /> Q.� 0 7 � � � Date Received: �l'� I G�ti�=, Permit# �t' �i%, � <br /> 2750 Kelley Pazkway `'�"a�/� n �r�U�'? ,� <br /> � �,Z� � Crysta l Bay,M N 55323 U�� pmount� S C.U.P Filed: <br /> ,��;��y (952)249�600 , � c,r�✓`� ✓n(,u�''� <br /> ` ` � Approvod By. Site Plan: <br /> J <br /> ` ��fi�/ Recommends: A roval ❑ �nial ❑ <br /> > � <br /> � � ����� (t> , �. <br /> ���`,��' ` � � � �� � �„ <br /> � ;� CITY OF ORONO - USER DEFINED/GENERAL PERMIT � <br /> � (All permits must be approved by the Building Official and or Zonmg Departrnent) 4'` �`� /_�/�p <br /> " (` V (/� <br /> Job Srte�Qv�ner Iriformation �Y'�`�� Y »�;: � <br /> \ <br /> Site Address: �-�!T � `_� ('�v�-���,r1,o J r � <br /> Owner: �� � N,L�;a� ����S�U�,,�ailing Address: � ,rv�tz, <br /> City: ���,��� Zip: ���'�� <br /> � � -� �` l.� I z. � 3v.� � <br /> Home Phone: I _>-=- �-1�]� `�I��!�-{ �� Alternate Phone: L 3�;�c� <br /> �C I���,,_��"Y`ti-- �'�crl.� <br /> Contractor/Applicant Information: <br /> Contractor/App.: ��,-�� . ��,��;�� �L,{ Contact Person: � � �� • G�_�� <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES:OF USER DEFINED PERNIITS ;' '` <br /> ��� <br /> ❑ Stairwav to Lake ❑ Retainin�Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surc;.arge General—User Defined <br /> * (Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: S <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' -$50.00(�eeds Sice Ptan) *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ ❑ 501'+_$'75.00(�e:ds C.L'.P.) <br /> General—User Defined <br /> ❑ Residential- $30.00 �� �Pr�,�i��l��� 3y G �,�,�c�� <br /> �J � <br /> ❑ Tree Removal �p�ut�v,�c� 1�ec�.. 150 ��� �c�n�) G,PProx" 3 -��-1 ��. ti'1 r� <br /> General—User Defined <br /> *Within 0-75' -$30.00 � �Cz'm�� �i:^ C.�'C 5�;r�c� �i� !���� �t� �%;'CC.�`�� (��;�,�e.c�� <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 pernut and work is not to start�s�ithout a permit;and that the work <br /> will be in accordance with the approved plan. <br /> �� ,_ _ � <br /> ,� � U� iO � I� _� <br /> � ,�� 1�c�,� � <br /> Applicant Date <br /> �Jtiei DcfniedF` .. <br />