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Cit of Orono <br />, � .¢,O� Y �r� FOR CITY USE ONLY�CY�i' �~� �' �C <br /> � � P.O.Box 66 Date Received: ��_ Permit# ��C � <br /> �;t 2750 Kelley Parkway <br /> � 1�����%'- Cr stal Ba ,MN 55323 ��tG � <br /> � �' Y Y Amount: $ C.U.P Filed: � <br /> �i��y�` (952)249-4600 ������ <br /> $BAO� Approved[3y: ,Q/� Site Plan: <br /> Recommends: A roval � Denial ❑ � <br /> � ���+��� ��:� ��-i ;� ��� �-�s�, �i��,��l�� - �c�r la�l� <br /> CITY OF ORONO - USE���F�-N <br /> (All pennits must be approved by the[3uilding Of6cial and/or Zoning Department) <br /> Job`Site/Owner Informatian: <br /> Site Address: ��2�� �--�r 1�ii ETT� �- ► DG T� ����-��2 � <br /> Owner: �� ��� J�-1�'� ��5 0�� Mailing Address: �At-t rL. <br /> City: � 2��c� Zip: �.��`� � <br /> Home Phone: �f �2 ' ��� I —�21 Z Alternate Phone: <br /> Contractor!Applicant Information: <br /> �1 r-i� , r� <br /> Contractor/App.: ��t„�1� ContactPerson: <- J� ,r.e�,� E=�-� 1e. <br /> Address: State License #: ` �� S"C��� <br /> � � <br /> City: Zip: Expiration Date: �� ����J�'1 ��C����- <br /> Phone: Alternate Phone: <br /> Tl'PES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retainin Walls ❑ Temporarv 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-One Time �rron-r�ke n�ttka) ❑ Land Alteration ❑ Zonin�Review <br /> General—User Detined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> ...._ <br /> *Estimated Cost: $ $50.00(Needs Site Plan) -''� � ' "�--�\ <br /> General—User Detined ❑ 501+Cubic Yards ������ \ <br /> ❑ Residential- $30.00 $50.00(tveeas c.u.P.) � i� � L � e� � <br /> �,'` _��1�C_C1���5�1 <br /> ❑ Tree Removal h�''S�-' <br /> General—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 underst i ' not a permit and work is not to start without a permit;and that the work <br /> will be in accordance w' the roved plan. <br /> ---- - <br /> � /� <br /> .......— ��� �� <br /> App icant �� Date <br /> /:. <br /> Ctta�.ac�wed P«rnii osro8Yo9j <br /> C <br />