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„ . <br /> ,¢0�� City of Orono FOR CITY USE ONLY <br /> Q Q P.O.Box 66 Date Received: Permit�i <br /> 2750 Kelley Pazkway <br /> \� ��1 ��` �”' Crystal Hay,MN 55323 <br /> "'i��.i�6' (952)249-4600 <br /> �a�t $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: A rwal ❑ Denial � <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> JS3�7,�1tC f�W�1�I��IIfO�i�latl0�}=3 � <br /> .�.:��, <br /> Site Address: ��� �...^{� �}(���,��� l��ti <br /> Owner: �v�� �S� MailingAddress: ��G (.-��e r��,.e,9 t�.. <br /> _ � <br /> City: Con Zip: �J53c1 � <br /> Home Phone: _ �S 2- U �3� Q$�S Alternate Phone: �J Z- `�7S- ��,/$� <br /> -�. �,'� ` �'�"� = ` <br /> ,._�.Y: ;:�. `3 . <br /> ,,.,�,��.,.� <br /> Contractor/App.: �-.� ��s � �. Contact Person: � �es' <br /> Address: �� (`�7(�r� 51�. �1C`b State License#: � .� <br /> � ��/ <br /> City: 5�-�...S ?�.,r..��ip; �{2(� Expiration Date: <br /> Phone: �J 2- �2(0- (a��q Alternate Phone: ��„'�-Z��Zy't._`j <br /> �' � c�, � <br /> s;=� �..�, F.:'x k � <br /> : , � , • . • .. <br /> _.. �. . <br /> � <br /> ❑ Stairwav to Lake Retainin�Walls \a�❑ Temnorary Trailer ; <br /> Grneral—User Defined Surchazge �General—User Defined Surcharge �, General—User Defined <br /> *(Per UBC� *(Per UBC) *$30.00 <br /> *Estimated Cost:$ *Estimated Cost:$���t90 <br /> ❑ Docks-42"or Greater �Land Alteration ❑ Zonin�Review <br /> Creneral-User Defined Surchazge General-User Defined � �� � General-User Defined <br /> ❑ Commercia(-(Per UBC) �( 0-500 Cubic Yards � � *ForO-75'Z�e-S30.00 <br /> *Estimated Cost:$ $50.00(Needs Site Plan) \�� <br /> General-User Defined ❑ 501+CubiC Ysrds � <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> Generat—User Defined <br /> *Within 0-75'-$30.00 <br /> � <br /> ; <br /> i <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and I <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 /> wor ' accordance with the approved plan. <br /> 9 zi o7 <br /> Ap t Date <br /> Reset Form (UsaDe6nedPasmit3/18/04) <br />