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' � ,¢0� City of Orono FOR CITY SE ONLY <br /> P.O.Box 66 Date Received: -�p'� Permit#�}���Z� <br /> ��� � r�� 2750 Kelley Parkway r;-��ti r� <br /> �; <br /> � q1�3 ���, � Crystal Bay,MN 55323 �) �� Amount: $ � , .�"C.U.P Filed: <br /> �' '1`�nii���` (952)249-4600 (.��� —�„— <br /> �",r�,,�t� <br /> ��H� Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pennits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owrler Information: <br /> Site Address: � � � � .• `��2 N�DP� , � <br /> Owner: ��,n�A S � ��u,���t l,U.��u� Mailing Address: <br /> City: [/U/�✓I Z.�.-r� Zip: S S � � � <br /> Home Phone: �� 2 � � (0 1 �(� v Alternate Phone: <br /> Contractor/ Applicant I�iformation: � <br /> Contractor/App.: � �� Lkr�c�SC.a�n�� Contact Person: �-(.� �� �� <br /> Address: 333 �- -r- ,�,lQ. �C State License #: <br /> �— <br /> City: S��li(,�� Zip: 5 S 3?�O Expiration Date: <br /> Phone: 7(� 3 �� 1 �Z o 0 Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General-User Defined Surcharge General-User 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) ❑ 0-500 Cubic Yards *ForO-7S Zone-$30.00 <br /> *Estimated Cost: $ �- $SQ.QQ rN�ice Ptan <br /> General-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 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 permit;and that the work <br /> will be in accordance with the approved plan. <br /> �� Z�o 'vL� <br /> Applicant Date <br /> (User De6ned Pem�it 3/18/44) <br />