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4(�� City of Orono POR CI'TY USE ONLY <br /> �� � P.O.Box 66 Date Received: Permit# <br /> � � �,,„tri 2750 Kelley Park���ay <br /> �'7���� Crystal Bay,MV��;'� <br /> ' ��'��t��tt��� (9�?)'_-19-d600 > <br /> �t,� I $v Amount: S C.U.i Filed: _ <br /> \� <br /> � Approved By: ��d' L� Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All perniits must be approved by the Building Official and/or Zoning Department) <br /> „ k z�� �G;. ., ,c��. -;; ' , ,,,�,;,, � '%� 1 <br /> �Cn - ( f� - 2� , i� _ L���L � <br /> Site Address: On former Dakota Rail Corridor from west Orono city limit, to east Orono city limit. <br /> Owner: Three Rivers Park District Mailing Address: 300 Xenium Lane N. <br /> City: P�Ymouth Zip. 55441 <br /> Home Phone: �763) 559-9000 Alternate Phone: (763)525-6210 <br /> Contractor/App.: SRF Consulting Group, Inc. Contact Person: Mark Hansen <br /> Address: � Carlson Pkwy N., Suite 150 Statc License #: 43920 <br /> City: Minneapolis Zip: 55447 Expiration Date: 06/30/08 <br /> Phone: ��63)475-0010 Alternate Phone: NA <br /> ����TTSER.D���. <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General—tiser Defined Surcharge General—Uscr Defined Surcharge General—User Defined <br /> *(Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks—42"or Greater ✓� Land Alteration ❑ Zonin� Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) 0 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> '� Estimated COst: $ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- $30.00 $50.00(veeds 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 t1�e information above is complete and <br /> accurate;that the work will be i conformance with the Ordinances and Codes of the City and with the State <br /> Buildin Code; that I unders d this is not a permit and wark is not to start without a permit; and that the <br /> wor 11 be in accordan e ' h the approved plan. <br /> � C . c � �7 <br /> Appli ant Date <br /> Reset Form <br />