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_. <br /> �;� '-�`��` \ City of Orono // FOR C[TY USE ONLY <br /> � /iQ¢ •r��, P.O.Box66 / ,�� Date eceived c_' Permit# /-,� //cT c c",- <br /> 2750 Kelley Parkway ��� � '�� <br /> �,�� ��y�� ,���j Crystal Bay,MN 55323 � � <br /> � ' ��.�;�y�� (952)249-4600 Amount: $ C.U.P Filed: <br /> �reuoa� <br /> Approved By: _i �" Site Plan: <br /> � - <br /> Recommends: A roval Denial �]� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERIVIIT/ <br /> (All permits must be approved by the Building Official and/or Zoning Deparnnent) � <br /> Job Site /Owner Information: <br /> Site Address: �6 S� �2r�-d�a.l�c. � • � . <br /> Owner: �flrv� oti � Sr�Wo�C�- Mailing Address: �{��j� ����.dl��t � ►`-' , <br /> City: �rortb , �� �.�-53`I I Zip: `553�i ( <br /> Home Phone: G S Z • �{�3 '�2- Alternate Phone: � <br /> Contractor/Applicant Information: � <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> n•. . 7'... c., t' + <br /> �.��y. �i�,. ��pira«on Ja�e: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake � Retaii�i Walls ❑ Temporarv Trailer <br /> General-User Detined Surchar�c General-Us F.J�efined Surcharg General-Uscr Defined <br /> * (Per UBC) " (Per UBC) \ * $30.00 <br /> *Estimated Cost: $ �Estimated Co�$ � • . <br /> __:�__. _. <br /> ❑ Docks—42"or Greater �� � Lan'd Alt ratibn � � � ❑ Zoning,Review <br /> General-User Defined Surcharge r General�, scr Define.d General-User Defined <br /> ❑ Commercial—(Per UBC) � ❑,'-50*0�Cubic�,,Yards \\ *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ �'� $50.f�0(Nee,Qs Site`Qlan) � 1� , <br /> General-User Defined � SO l+ �C Ya1'CIS `!� `��� � <br /> r � <br /> ❑ Residential - $30.00 $50.00( eds C.uP.) � �L�� <br /> �. <br /> ❑ Tree Removal _ �� � , <br /> General-User Defined �' ��� <br /> * �Vithin 0-75' -�30.00 � <br /> [ herby apply for a User Detined Per' ;�and 1 acknowlcdge t11at thc information abovc is complete and <br /> accurate; he tivor�c�vi(1 be:}n ca o°y�(i�nce with the Ordirances ar,d Codes of the City and with tile State <br /> Buil ' g o e• ��at I �i der '�n}�t. f5 not a permit and work is not to start without a permit; and that the <br /> �v w' e n ccor ance '' 1�����r ved plan. <br /> �` : <br /> � � ��, � � � <br /> y A�plicant Date ` <br /> � <br /> '"� ����Y ��� ;tis..pef�A,�p<..�,.�����.qrnq� <br />