Laserfiche WebLink
. ,�0�` City of Orono 1 v " � FOR CITY USE ONLY <br /> `r P.O.Box 66 Date Recerved: Pennit# <br /> �?y,S � 2750 Kelley Parkway <br /> � ��'�'��`''� Cr stal Ba ,MN 55323 <br /> p`� �' Y Y Amount: $ C.U.P Filed: <br /> 'u�°��y'l"�;�yo` (952)249-4600 <br /> ��°�� Approved Dy: ,�0• __ Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> � C�) <br /> Site Address: �.S O �'MS .�,0 1►.�1�.9 �j � <br /> Owner: 1atw�.�, -F�� �,�vt�s,SS Mailing Address: � �� +��. <br /> City: [�.)rbv1� Zip: rj`j?j(A� <br /> Home Phone: (P��.•a.O�•�J I�(� Alternate Phone: �p/.2• 3 p(� •�o�� <br /> Contractor/Applicant Information: � � <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ` TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake � Retainin�Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge Genera]--User Defined Surcharge General—User Defined <br /> *(Per UBC) * (Per UBC) / * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ .CGC1• <br /> ❑ Docks-One Time �tvon-[.ake Mtka) ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(tveeds s�te p�an) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General- User Detined <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 C ,that I understand this is not a permit and wark is not to start without a permit;and that the work <br /> wil in ardance with the approved plan. <br /> � i� 4 <br /> App icant Date <br /> �u5«cxsnea rem,n os�os�o9� <br />