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. r <br /> ,���\ City of Orono FOR CITY USE ONLY , <br /> P.O.Box 66 Date Received: 'i;i�;,�! Permit# ��� <br /> ��;�;.:,,;� � 27�0 Kelley Parkway •� � <br /> � �1'�r�'<<'- '� Cr stal Ba MN 55323 , � � , ;�i 1 '�C^, <br /> ,y q �_ti - �, Y Y, ,� �, Amount: $ C.U.P Filed: <br /> �`'�kr�t;�1�$�, (952)249-4600 � �\� � �.(� <br /> ssxo� � �" �' \''':: APproved By: Site Plan: <br /> ! y <br /> Recommends: A roval ❑ Denial ❑ <br /> CIT1' OF ORONO - USER DEFINED/GENERAL PERl�ZIT <br /> (All pennits must Ue approved Uy the Buildin�UfTicial and/or Zonin�Depar[menl) <br /> JoU Site/Owner I�Zfornlation: <br /> Site Address: � /��7 � I������� ;`���� <br /> Owner: ;''�//nl //i �/,��'(� 1��� Mailing Address: <br /> City: �����1 j� Zip: <br /> Home Phone: �� �,������ � ��� Altenlate Phone: <br /> Cont�-actor/Applicant I�iformatio : <br /> , <br /> Contractor/App.: , � Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake � Retaining Walls ❑ Teinporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) m� * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $�p o� � <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zonin2 Review <br /> General—User Delined Surcharee General—User Defined General—User Deiined <br /> ❑ Conunercial—(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $SO.00 (Needs Site Plan) <br /> General—User Detined ❑ 501+CubiC YaTds <br /> ❑ Residential- �30.00 $50.00(Needs C.u.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Witlun 0-75' -$30.00 <br /> I herUy apply for a User Defined Permit and I aclrnowledge 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 pei�nit and work is not to start without a permit;and that the work <br /> will Ue in accordance with t�_ap�plan. <br /> � — � � <br /> p,ppji�anT----- Date � <br /> �usa ne��a r�c 3�isioa� <br />