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,���\ City of Orono FOR U ONLY <br /> ' ' � � P•0.Box 66 Date Received: �pemiiE#����� <br /> �,,,,i 2750 Kelley Parl.tivay <br /> �, �I��.,'?�;�� Crystal Bay,MN 55323 <br /> �'��o�r�y (952)249-4600 Amount; $ C,U.P Filed: <br /> Approved By: '� Site Plan: �S� <br /> ��� S� <br /> 2;�:�. <br /> Recommends• A roval Denial Q <br /> CITY OF ORONO -USER DEFINED/GENER.AL PERMIT <br /> (All penniu must be approved by the Building Official andlor Zoning Department) <br /> 7ob Si-te./Owner Information <br /> Site Address: �� ��� �'� �Nl �/J�L./"�f�/� <br /> Owner: l7'r 6(c,.� ..SI�c�Yl�fry Mailina Address: <br /> City: O d0 nU Zip: <br /> Home Phone: 9S�' �73'��� A(ternate Phone: <br /> Contractor/Applica�t Inforinatiori � = <br /> Contractor/App.: �Gl r h J �k<- Contact Person: ,�J rvz 6ec�.,s <br /> Address: �6/� /a /�� „�� State License #: � ��Y <br /> City: �idT*�T�h Zip: �,�� Expiration Date: <br /> Phone: �S1� �.5�" �/��- Alternate Phone: ���" ��f �/,JO� <br /> .�::} �.- -- , ' F � . TYPES OF:tTSER DEFINED PERMITS' .;,`. <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Tem�orarv Trailer <br /> General—User Defined 5urcharge General—User Defcned Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *�30.00 <br /> *Estimated Cost: $ *Estimated Cost:$ <br /> ❑ Docks-42"or Greater �Land Alteration ❑ ZoninQ Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$3p.00 <br /> *Estimated Cost:� $50.00(Needs Site Plan) <br /> General-User Defined �501�-CubiC 1'ards <br /> ❑ Residentia]- �30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * W ithin 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 /> .��ork���ill be in accordance with the approved plan. <br /> U� j- Lf- C� ? <br /> Applicant _ . Date <br /> . Re��,'e,t-F��'m . . (UsarlJeFinedPetcnit3l18iUd1 <br />