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,��� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: Permit# <br /> �y��,:� � 1 37�0 Kelley Parkway <br /> a �!'��'�i:��- '� Crystal Bay,MN 55323 Amount: � C.U.P Filed: <br /> x 1 1:,ta;-.-' � <br /> �t�'��!y�;1i�$� (952)249-4600 ��� <br /> ��eKO� Approved By: ��f!(Jr�..-- Site Plan: <br /> v�►�— <br /> Recommends: A roval Denial ❑ <br /> /G'?•t�-U`f <br /> CITY OF ORONO - USER DEFINED/GENERAL PERI�ZIT <br /> (A11 pemiits must Ue approved Uy tliz Buildine Official andlor Zoning Depaitment) <br /> Job Site/Owlier I�zforniation: <br /> Site Address: ��i� �--�+'Yt« �-.•�.��c�,��. <br /> , <br /> Owner: 1CQ-�'��. � „��� � Mailin�Address: `��-��--` <br /> City: 1,n�.-� Zip: �;s� G�-f <br /> Home Phone: Alternate Phone: <br /> Cont�-actor/ Applicant I�iformation: <br /> � ' <br /> Contractor/App.: Cc-�n c,z.p� �c��.����Contact Person: �'1� ����-� <br /> Address: 3 1 S 3 ���� �.,e,.,.�-- State License #: <br /> City: � Zip: SS 3b`-1 Expiration Date: <br /> Phone: ��Z `� l L `E < < � Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> Stairway to Lake �- Retaining 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: � �c e 2� ' C *Estimated Cost: $ <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Re�-•iew <br /> General—User Defned Surchar�e General—User Deflned General—User Defined <br /> ❑ Conunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-�30.00 <br /> * Estimated Cost: $ $50.00(Needs Site Plan) <br /> General—User Detined ❑ 501+Cubic Yards <br /> ❑ Residential- �30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 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.�n. e•that I understand this is not a permit and work is not to start without a pern�it;and that the work <br /> will be in accor ance with the pprov�ad plan. <br /> ��.�� � �� ( ► �� I z�� <br /> Applicant Date <br /> (User DeSned Pennit,3l1 S/04) <br />