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, ¢�� City of Orono FOR CITY USE ONLY <br /> , � Q P•O.Box 66 Date Received: ° Permit# ���r:3/ <br /> �;;t,�, 2750 Kelley Parkway ,N <br /> a t��� R � Crystal Bay,MN 55323 Amount $ �W � C.U.P Filed: E1 A <br /> ����k�`�'o°� (952)249-4600 �-f`�•o� <br /> saxo� o,f�+-t i./ <br /> Approved By: L• `'Site Plan: �" <br /> Recommends: A roval [�� Denial ❑ <br /> C�' <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT ,��ti'���, <br /> (All pemiits must be approved by the Building Official and/or Zoning Department) <br /> Job Site /Ov�nier Inforniation:; <br /> Site Address: 35 °J�J' �VU �(�'�- <br /> Owner: r�te �Ps Z 1 � Mailing Address: S� 2-� <br /> c�ty: Hlr��l� z�p: Ss3�l <br /> o��� � `�'� �5 Z - 4 s� - �78� <br /> �a�e-Phone: �S Z-85 Z -`f D� Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.:��U2,1-�v�¢. �� rl l'1L. Contact Person: � <br /> Address: (p(`{�j jO�S�YQ��- (�� State License #: <br /> City: �N'� Zip: �'S3(3 ExpirationDate: <br /> Phone: 7(o�j ' (o �'"' ��� Alterna�P�hone: �(Z.. -�� -(C7Cj� <br /> �r cl <br /> TYPES OF USER DEFINED PERMITS <br /> []�Stairwa�to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—42"or Greater ['�Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Corrunercial—(Per UBC) [�]'0-500 Cubic Yards *ForO-7S'Zone-$30.00 <br /> *Estimated Cost: $ ��D.$O(Needs Site Plan) 's I0�•od —c�A�bk Cn�. _SF�M�o.-dj <br /> General—User Defined ❑ 501+Cubic Yards WuK w�N�ov� �,v vti�E , <br /> ❑ Residential- $30.00 $SO.00 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * Within 0-75' -$30.00 <br /> I herby apply f a User ned PernZit and I acknowledge that the information above is complete and <br /> accurate; that e w will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building ; at I understand this is not a pemZit and work is not to start without a permit;and that the work <br /> will be � ordance with the approved plan. <br /> � �Cp -- � <br /> � � � <br /> Ap nt - Date <br /> fiJser De6nr,d Pertnit 3/18l041 <br />