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� ��t� af ��°ono <br /> , . <br />� � � �onir�g �errrsE� �4 ��ca���� <br /> Mailing Address: Permit number: 0�0/�-� Q9 <br /> ��� PO Box 66 <br /> O Crystal Bay, MN 55323-0066 Date received: 3-�/-/� <br /> Escrow#and <br /> Streef Address: amount: �l� <br /> �, � 2750 Kelley Parkway <br /> d � Orono, MN 55356 Permit Fee: N/� <br /> � G <br /> �qkFSHO�� Fax: 952-249-4616 Approved by: <br /> Main: 952-249-4600 Notes: <br /> v,n���.ci.c-ono.mn.us <br /> This application form must be completed in full and all required information must be submitted. (P/ease print.) <br /> Job Site Address: <br /> CONTRACTOR/APP ICANT INFORM�4TION: <br /> Name: ���« �� �� . � <br /> Phone: ` <br /> _ -� � Fax: <br /> Add�6Ss: �� �� ;? lr r: r�r� CitV' C> � Zlp• S -3C f <br /> Contact Person: ������,�,�E_!z �, Contact's phone number }��-, � <br /> Email �"� ? -� S 4-f��Z <br /> ,. Applicant is: Contractor Homeowner (Circle One) <br /> l�'m <br /> PROPERTY OWNER INFORMATI N: <br /> Name: G��� -' .� ti r��� <br /> Phone (day): tn_ �z �,-� z _��, ��,� � <br /> Mailing Address: �,, �i �.�;,�_� <br /> ZIP• <br /> Email and/or Fax <br /> Overall Project Description: <br /> - Cbeck - __ _ _ . -- - � - — <br /> BoX TYPE OF PERIVIIT <br /> collected when ermif is issuea <br /> Dock, Commercial $50+engineering review costs <br /> Escrow for erosion control and en ineerin review costs $2,000 <br /> Dock, Residential - Permanent dock on any lake or initial seasonal dock not on Lake $50+engineering review costs <br /> Minnetonka ermanent dock re uires CUP <br /> Hardcover Permit: Driveway, Patio,Sidewalk,etc.(New or Replacement) No charge <br /> Also re uires is a Minor or Ma or Land Alteration Permit <br /> Land Alteration, Major (grading, filling, or excavating) of more than 500 cubic yards $50 <br /> beyond the lakeshore setback OR more than 50 cubic yards within the lakeshore setback <br /> (also requires Conditional Use Permit) � <br /> �Reference: Citv Code Sections 78-967 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs As determined b CUP <br /> Land Alteration, Minor(grading, filling or excavating)of 51 to 500 cubic yards beyond the $50+engineering review costs <br /> lakeshore setback OR 50 cubic yards or less within the lakeshore setback <br /> lReference: Citv Code Sections 78-967 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs $2,000 <br /> Retaining Walls which exceed two feet in height above existing grade; or result in more $50+engineering review costs <br /> than 20 cubic yards of imported fill; or are located less than five feet from the property line. <br /> Escrow for erosion control and engineering review costs $2,500 <br /> fReference: Citv Code Section 78-1405f5 1)1 <br /> Retaining Walls which measure more than four feet(from bottom of footings to top of wall) <br /> require a building permit. Tiered retaining walls are considered one wall unless the walls <br /> are se arated b twice the hei ht of the lower wall. <br /> Stairway or Lifts to Lake(New or Replacement) IReference: C;tv Code Sections 78-12821 $50+engineering review costs <br /> Escrow for erosion control and engineering review costs $2,000 <br /> Structure Permit for other structures 200 sf or less not requiring a building permit but $50+engineering review costs <br /> regulated by the zoning Code�Reference: Ciri Code Section 86-661 <br /> Escrow for erosion control and en ineerin review costs $2,500 <br /> Tree Removal or other vegetation removal within 75 feet of lakes No charge. <br /> Reference: C Code Section 78-1285 Pre-inSpeCtion required. <br /> Tem ora Construction Office/Trailer associated with buildin ermit $30 <br /> Updated: May 2015 <br />