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Q`~ City of Orono �/ �� �a <br /> 'g' ��� FOR C1TY USE ONLY <br /> P.O.Box 66 Date Received: Permit# <br /> �+is�•. �`'1 2750 Keliey Pazkway �/ <br /> � �l��}'''�`� � Crystal Bay,MN 55323 � ���� ST�U'3 <br /> \ -. �1'" <br /> �7�_,ij�'i`�'�,� (952)249-4600 <br /> ��80� Amount: $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - U5ER DEFINED/GENERAL PERMIT P� �� �"`�Or' <br /> (All permits must be approved by the Building Official and/or Zoning Department) �� <br /> C� <br /> Job Site/Owner Information: <br /> Site Address: �-�7U �.�i� �}j`����� �,y <br /> Owner: �e�Y� 1-�^'�S�f Mailing Address: ��CG C.-��� ���„�,9 �_ <br /> � <br /> City: ��on �i Zip: ��J� � <br /> Home Phone: �S 2- y�,�� �;$7� Alternate Phone: `�J Z- y 7�- 3jy� <br /> Contr�ctor/Applicant Information: <br /> Contractor/App.: )�.�-c�c� �jC�O��.3n�_ Contact Person: �rS ��eS <br /> Address: �U� �j�(�r� S�. �i�Z; State License#: � .� <br /> City: 5�-�'•S ��-�Y.�,,�lp. �-�{2(p Expiration Date: �''/ <br /> Phone: �J 2- �2�- (��`j q Alternate Phone: ����-Z��Zy'Z�j <br /> ���.�.�����?����"k'���� ° ��`��:����P��.S OF TJSER.DEF'IN'ED PERMITS � � � �' � �' <br /> , �„�� <br /> - -_ _.,. <br /> �v. .� __ . <br /> ❑ Stairwav to Lake �Retainin�Walls 1�1\a� ❑ Temporat�Trailer <br /> General—User Defined 5urchazge General—User Defined Swchazge � General—User Defined <br /> *(Per UBC) *.(Per-�}g�j' *$30.00 <br /> *Estimated Cost:$ *Estimated Cost: $ �% <br /> __..._..._ _ <br /> ❑ Docks-42"or Greater -�Land Alteration ❑ onin Review <br /> General—User Defined 5urchazge General—User Defined Ge era!—User Defined <br /> �S. � <br /> ❑ Commercial-(Per UB � 0-500 Cubic Yards 2�� �� * r0-75'Zone-$30.00 <br /> * Estimated Cost:$ $50.00(Needs Site Plan) �\� <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30. 0 $SO.00(Needs C.U.P.) �a S 'n' Qt�"��`` <br /> _ _. <br /> _.._._._....._....... L.r I fl i �� 3 0/`�c....( <br /> ❑ Tree Removal ` � <br /> General—User Defined � <br /> * Within 0-75' -$30.00 C � ��� <br /> �n �. <br /> ;+ <br /> I herby apply for a User Defined Permit and I acknowledge that the informati�t� u.,.,�� „ t,v111�71G1G tlll(1 <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 /> � 2i D-7 <br /> App ant Date <br /> Reset Form (User DeSned Pertnit 3/18/04) <br />