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"'� City Of Orono FOR CITY USE ONLY <br /> �¢ �0,, P-O.Box 66 <br /> Date Received: �77/LO�cS Permit# 74��`�C4� <br /> , 2750 Kelley Parkway <br /> �+ r_i'x• ,��� Crystal Bay,MN 55323 (�3 <br /> `� t�� (952)249-4600 Amount: $ I 3 g � C.U.P Filed: <br /> ���oe <br /> Approved By:��(J 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 Depatbnent) <br /> Job Site/Owner Information: <br /> Site Address: 3�3`}� ��0..CR-- <br /> Owner: �'e.� (��ca rla- Mailing Address: <br /> City: C�n,Qv..o Zip: �S 3� � <br /> Home Phone: ��a - a.y� - a► �o z. Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: Contact Person: ��.,�,n ����� <br /> 315�.P�97 l.N <br /> Address: ��;ut�t � State License#: <br /> City: Zip: Expiration Date: <br /> Phone: 9 5� - �►�� - �1 f� � Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> [�Stairway to Lake ❑ Retaining Walls ❑ Tempora�r Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost:$ Z-�C�O *Estimated Cost:$ <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+CubiC Yazds <br /> ❑ Residential- $30.00 $50.00(Neeas C.U.P.) <br /> ❑ Tree Removal _ <br /> General—User Defined �,�„� �2,.��,�_ �;u,��1,� 5��,p..-,...>� <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 be'n accordance with the a roved plan. <br /> � � <br /> �--- �� '7"l�- "1 - ti l - o� <br /> Applicant Date <br /> Reset Form N���p��t3/18/04) <br />