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� <br /> /p�� City of Orono <br /> 4" �U � ��, FOR IT 'U5E ONLY <br /> �._ 0 P.O.Box 66 Date Received:/ Pemiit�+����� <br /> 4 . 2750 Kelley Parl.tivay <br /> � �1���;�- � Crystal Bay,MN 55323 _. <br /> �'��'t1�,n�'y�, (952)249-4600 <br /> s�o� Amounk $�Q"/� C.U.P Filed. <br /> Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (Alf penniu must be approved by[he Buil ding Official and/or Zoning Department) <br /> -;Job Site/Owner Iilforination; ' <br /> Site Address: STUBBS BAY, ,3WAN LAKE �5 � �e � �Q C� <br /> Owner: MINNEHAHA CREEK MaiIin� Address: 18202 MINNETOKA BLVD. <br /> WATERSHED DISTRICT <br /> City: DEEpHAVEN, MN Zip: 55391 <br /> Home Phone: �5 _4�� —0�c�� Altemate Phone: <br /> ,Gontractor/Applicant Information ',`.� -; <br /> Contractor/App.: SUNRAM CONST. Contact Person: PAUL KERANEN <br /> Address: 20010 75 TH AVENUE NORTH State License #: 81 15 <br /> City: CORCORA�i, MNZIp: 55340 ExpirationDate: 3-31-08 <br /> Phone: 7h�_4��_ � 4n AlternatePhone: 612-282-7771 <br /> _ •.:`�. F- . 'TYPES OF.U�ER DEFINED PERIVIITS .. , ' <br /> ❑ Stairwav to Lake ❑ Retainin� Walls <br /> ❑ Temporarv Trailer <br /> General—User Defined Surcharge Generai—User Defined Surcharge Generaf—User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: $ * Estimated Cost:$ <br /> ❑ Docks-42" or Greater � Land Alteration <br /> ❑ ZoninQ Review <br /> General—User Defined Surcharge. General—User Defined Gencral—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ �SO.00 (Needs Site Plan) <br /> General-User Defined � 501+Cubic I'ards <br /> ❑ Residential - �30.00 �50.00(iveeds C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * Within 0-75' -530.00 <br /> I herby apply for a User Defined Pennit and I acl:no��led�e that the infonnation above is comp(ete and <br /> accurate;that the work will be in confonnance with the Ordinances and Codes of the City and with the State <br /> Building Code; that I understand this is not a permit and work is not to start without a pennit; and that the <br /> «�ork will be in accordance ���ith the approved plan. <br /> �. �;� �Liti����'�'t _ t 2- - i � � ��`�j <br /> Applicant __. Date <br /> Reset Form (Use;Dcfin_cPcr,nit3lld-��, <br />