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O,¢p�O City of Orono , F�.�i�'Y�i.t�E Orti.���l � <br /> P.O.Box 66 � Date Received: 1`�l �Permit# �( <br /> 2750 Kelley Parkway n <br /> � � ��- � Crystal Bay,MN 55323 '�/ Amount: $��� C.U.P Filed: <br /> . ��'� `6�,� (952)249-4600 i I� <br /> �° � Approved By.�%�� Site Plani �i ld'd 7 <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pem�its must be approved by the Building Official and/or Zoning Department) <br /> Job:Site./,Owner>�ormat�on: <br /> Site Address: ���� �/'!'�,y �� '�„�-f <br /> Owner: ' Mailing Address: ��?�,�DD,�G� L�vt�'��. <br /> City: ��C'7 V�� Zip: <br /> Home Phone: ����'y��'���� Alternate Phone: <br /> �onfxacto��.�1pp�licant°I�:forinahon ,��' <br /> Contractor/App.: ` � ontact Person: � �'Z�1" <br /> v <br /> Address: ,�/.���jT�C��/�� State License#: <br /> n <br /> City: �y�j�rtr Zip:���� Expiration Date: �� "G <br /> Phone: �1��j� � Altemate Phone: ��j'r-,�'�f 7�� <br /> �:� ; �TYPES QF�CTSER-DEFINEn�PERMITS ` ' <br /> {� Stairway to Lake ❑ Retainin Walls ❑ Temporarv Trailer <br /> /` General—User Defined Surcharge General—User Defined Surcharge Genenl—User Defined <br /> *(Per UBC) � *(Per UBC) *$30.00 <br /> *Estimated Cost:5������� *Estimated Cost: $ <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost:$ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 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 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 pemut;and that the work <br /> will b � accordanc with the approved plan. <br /> �--��' �'G 7 <br /> Ap icant Date <br /> lUset De6ned Pumit 3/18/041 <br />