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. _ oD�� / <br /> "� Ci of Orono " � <br /> ¢�d�i�\ �' OR ITYU ONL <br /> P.O.Bo�66 <br /> Q a ,/ pa Recei ed: Pemiit <br /> �� 2750 Kelley Parkway �[ Lj <br /> � l�ly'p���. '� Crystal Bay,MN 55323 ��/� (� �. �y-� <br /> \�tl��i4 y�� (952)249-4600 "��/J � Amount: $�•W C.U.P Fi(ed: <br /> �o� ,i � <br /> �� Approved By: __�� Site Plan: �� , � <br /> � � <br /> �j�7 Recommends� A roval � Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pennits mus[be approved by the Buildir,g Official and/or Zoning Department) <br /> Job Site/Owner Information. <br /> Site Address: � .i�� �i <br /> Owner: ���,p����'��5� Mailin�Address: �. � �� � <br /> L��-`� 1-`� �"`'►'' — <br /> C1Ly: C/�� Zlp• —cLiJ���' <br /> Home Phone: ��?i�"I b�j'�J�� _ Alternate Phone: <br /> Contractor/.Applicant Inforrriatiori: <br /> Contractor/App.:LA'►�►c�S�„(� ��/�,�- Contact Person: l e �� <br /> Address; ���.t ���c�riv� �S ;tate License #: ZG� �(o�((� � <br /> City: � Zip: ��Zc� Expiration Date: �j_�'O g <br /> Phone: �' �����°�`l-1 � Alternate Phone: ��� ��J'I,�IO Z- <br /> � .�-:: =: TYPES �F USERbEFINED PEIt1VIITS ' . <br /> ❑ Stairwav to Lake ❑ Retainin� Walls <br /> ❑ Teinporary Trailer <br /> General—User Defined 5urcharge General—User Deftned Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: � *Estimated Cost: � <br /> ❑ Docks—42" or Greater ❑ Land Afteration ❑ ZoninQ Revie�v <br /> General—User Defined Surcharoe General—User Defined General—User Defined <br /> ❑ Commercial—(Per USC) ❑ 0-500 Cubic Yards *ForO-7S Zone-$30.00 <br /> � Estimated Cost: � $50.00(Needs Site Planj <br /> General—Use,Deiined 501 T CubiC�'ards <br /> ❑ Residential- �30.00 �50.00 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User De6ned <br /> * Within 0-75' -�30.00 <br /> I herby apply for a User Defined Permit and I ac{:no�i�ledQe that the information above is completz and <br /> accurate;that the work will be in confonnance with the Ordinances and Codes of the City and�vith the State <br /> Building Code; that� unders nd this is not a permit and work is not to start ��,�ithout a pennit; and that the <br /> ��ork �vill e 'n acco aance � ith the appro��ed plan. <br /> 1 (�_ �%-�� w��� <br /> �( <br /> Appiicant _. _ Date <br /> . ReSeI.F��'m . (UserDeSaedFcccnit3:13iU11 • <br />