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. . i�` Cit of Orono <br /> � / /,�0,� Y FOR CITY USE ONLY <br /> �� � P.O.Box 6G �� �� Date Received: — � fl Permit� ��/D'�U � � <br /> �� a�{,1,4.�.P 2750 Kelley Parkway <br /> � �� ,� Crystal Bay,MN 5532 3 n 'I I� Amount: $ S� •�U.P Filed: <br /> ��,,.���y�� (952)249-4600 � � ��(( � <br /> ��O$ �� Approved By: Site Plan: <br /> Recommends: A roval [/� Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> r <br /> Site Address: � � 7� � �-- ' �., . <br /> a I p f <br /> Owner: l o�d. i v r Mailing Address: ai���j ('�oc�n.�s t d.e,�i d , <br /> v <br /> ��ty: a �.o Z�p: s�3s � <br /> Home Phone: R��' �fb''�- Oa,O � Alternate Phone: <br /> �Contractor/Applicant Infornlation: � <br /> � <br /> Contractor/App.: �T,�t�,�n,�� C ,,�, ,►� Contact Person: <br /> ' I a <br /> Address: �� �l �3r S� 5 F-- State License #: <br /> City: �l���,r10 Zip: 55� Expiration Date: <br /> Phone: � -/ 3 'S `� Alternate Phone: <br /> D ? ?O � <br /> � �TI'PES,U�"USER������DEFINED�PERMITS � ����� . ' <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Detined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—One Time(No„-�ke Mtka� ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—liser Defined General—User Defined <br /> ❑ Commercial—(Per UBC) ,�] 0-500 Cubic Yards � *ForO- 5'Zone-$30.00 <br /> * Estimated Cost: $ $50.00 (Needs Site Plan) �� �(� � ������ <br /> General-User Defined ❑ 501+Cubic Yards ��'� c <br /> e .�- <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) � � �� S' � o� `� �d r ►`I <br /> ❑ Tree Removal �Jy1 G d-� ��, �O f� �.J�O!`•T l�O c� r� <br /> General—User Defined <br /> *Within 0-75' -�30.00 �S� ��� � �- ���j� � ,�� « <br /> �• 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 ode;that I understand this is not a permit and work is not to start without a permit;and that the work <br /> will b accor nce with the approved plan. <br /> 0 � lD <br /> Applic Dat <br /> (TJser Defined PeRnit OS/08709) <br />