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, x . <br /> 0 City of Orono �:� + : FOR CITY USE•ONLY � <br /> 4 �� P.O.Boa 66 Date Recerved � Permit# <br /> �¢y� 2750 KelleyParkway �;' •�L��. <br /> , � ��r;'i,.• +� Crystal Bay,MN 55323 •Amount: :...�.•$� � ' •C.U.P.Filed: <br /> �� o� (952)2491#600 . . :•�• ; <br /> {'!'4'aes°$� �APPmvedBy: .� <: � �S►tePlan: <br /> �`Recommends: A roval � �� Denial �:� ,�.: <br /> , . f,��� <br /> CITY OF ORONO —USER DEFiN�D/���t�R��Pt � '+ ' a �I'-'`i �:�"���;:� <br /> (All permits mustbe approved by the Building Official and� ; ' D p g�t) <br /> �Job�;S1tC I;�OW1l.�I'III�OIIL12.t10I1.,��''�� �'h � �� '� Y' " <br /> . ��� � <br /> ,,�,,... .�.._�w�... r..... .� .,� <br /> . ��........_._.__....:i�;s:z:�� �¢1 (.�t�'����-si-t . <br /> � .Site Address: ��S S 1� r1 ke.�rc , - <br /> .Owner: - �v-SS� Sc.�..�--re.�' Mailin�^Ad�l��ess , � - - - 't}rt�: <br /> City: �J`�v�J Zip: <br /> . Home Phone:� � ' � AlternatePhone: C� �Z�7 S � - � `� t r <br /> �:.�� � �Gon�rac��''/�{� f``l�can�7�formatron�4��aJ 4`�,L'.y y`h� � . ,. � "��• <br /> Y PP�. . � >.�_:.._�,. ,.�_p �.�,.,_..� �..._<rt�.. :,f;� . , <br /> • ; <br /> ..:,, ..._...., �� . <br /> Contractor/App.: ��'� -����4 ��c. � Contact Person: �' G �c.�,.�-+a-r`tz <br /> � Address: 7l�v 6�f �- /�c/c:. State License#: 1 �/ ! - � � . <br /> � City: ���-�'���•�r� Zip: SS3?� ExpirationDate: � <br /> Phone: ��`31�7 �� S ( ?�-- Alternate Phone: CG �Z--� �G�- (�Z�Ll : <br /> l <br /> � � •vJ`�e �k�: s.�, •.� �w�t J �,r�. , .: ... .. _ . - �a�1�uTx„ -�nr�`t y�,�l��:i�ti fY2'�� ��, .. ... . . <br /> K .. �. <br /> 4`.��t.�:�JV.{�bry'Gu�.'.��.','�71:��,�3i7*u���N.r_':�ti„I'�P�S�OFr'CT:S�+R.�,�.��, < ;.... D�pE��tNII`I'S -.-�. �_... d ��r.A`�r�..: <br /> ' _ ..7 _ ..xt,c� ..P :.�..r'P..t':.V'�..�'.. <br /> to e ❑ Retainin�Walls ❑ Temporarv Trailer <br /> Gen r efine rcharge General—User Defined Surcharge Geneml—User Defined <br /> C *(Per UBC) *�30.00 <br /> Es ' e . �°� *Estimated Cost: $ <br /> 0 Docks-42"or Greater �Land Alteration : ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Comruercial-(Per UBC) � 0-500 Cubic Yards *ForO-75'Zone-�30.00 <br /> *Estimated Cost: $ $50.00 (Needs Site Plan) � <br /> General-User Defined Q 501+Cubic Yazds <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 Pernut and I aclmowledge that the informat�on 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 pemvt;and that the work <br /> will be in accordance with the approved plan. <br /> s���/�.�- <br /> Applicant � Date <br /> � . fI15c�De6ned Pttmit 3!I R/041 <br />