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�yj,�' <br /> � �- , <br /> � ¢�� City of Orono F�CTTY USE ONLY <br /> O � P.O.Box 66 Date Received: 2 t�Permit# f�C SSL; _��- <br /> 2750 Kelley Parkway <br /> � ,,;'`. ; Crystal Bay,MN 55323 arp <br /> � (952)249-4600 Amount: $50� C.U.P Filed: <br /> � <br /> �tAHo4 <br /> Approved By: �te Plan: <br /> �•2�-os <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 Departme�t) <br /> Job Site/Owner Information: <br /> Site Address: �- � �- C' /-/��%'�'� }� <br /> � �l -� � f <br /> Owner: �-'��'► rTO�✓Z-�. - i '��►)��t' Mailing Address: �=�� � � rin��h Crr�F�. ����E <br /> City: f�J��/L/C 1 zip: � > � �� <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> � ,I <br /> Contractor/App.: C'� ���1 �,.� �`�-�.S . Contact Person: t��,ri'�-�� .S�H s"Z��,✓��'` <br /> Address: � ���' �J ��%z��!� ����L> State License#: <br /> City: �� "�'� C�F�� Zip: ,J 5 �� 7 � Expiration Date: <br /> � � __ � o . <br /> Phone: jJ`�Z �� �� � ���� Alternate Phone: /� Z �I 3 `� ��' '> <br /> TYPES OF USER DEFINED PERNIITS <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temnorarv Trailer <br /> General–User Defined Surcharge General–User Defined Surcharge General–User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estim�ted Cost:$ <br /> ❑ Docks-42"or Greater � Land Alteration ❑ Zonin�Review <br /> General–User Defined Surchazge General–User Defined General–User Defined <br /> ❑ Commercial-(Per UBC) � 0-500 Cubic Yards *ForO-75'Zone-$3(1.00 <br /> * Est3mated Cost: $ $50.00(Needs Site Plan) <br /> General-User�efined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> Genetal–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 <br /> work will tie in accordance w�h the approved pian. <br /> ^•;�t�`",,'�� ;� r,� ' — c�'_ � -Z _L> > <br /> App �ant Date <br /> Reset Form N�`°``'"`°pQ11"�"�'°°, <br />