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� , ,��� City of Orono FOR CIT�USE ONLY <br /> P.O.Box 66 Date Received: L-� '�� Permit# <br /> �" �1 �7j0 Kelle Par6�wa <br /> , a`e„.� Y Y ^n <br /> � `���'�'r1} � Cr stal Ba ,MN 55323 ��. . <br /> 1 � Y Y Amount $ � .t'4 C.U.P Filed: <br /> 6 9,��;ll%-:'" � <br /> � ������7�:v $� (9sz�za�-a�oo ���. <br /> ��axo� <br /> ApUroved By: � J Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERl��IT <br /> (All pennits must be approved by thz Building Official and/or Zonino Depaivnent) <br /> Job Site/ Owner I�zfornlation: <br /> SiteAddress: ll7" Cd "�4 ���� �''��• � ��� <br /> Owner: ��� �f��J� �9U�e( ���l�; Mailing Address: ���' �rt� L jt�Q.�p, <br /> City: �{'�� Zip: �� ,3�� <br /> Home Phone: ��Z -`�'l - ��Z- � Alteniate Phone: �S� -� �]L -'�y� <br /> Cont�-actor/Applicant I�iformation: <br /> Coiztractor/App.:��i� � � ��,�.�-C. Contact Person: /��s� L,�}-f���,� <br /> Address: Z�3�Z} (l)K w'�-r�Zr1�7F �liJ(� State License �: <br /> City: Cc�M� �-� Zip: �,� Expiration Date: <br /> Pl�one: 9�"Z -'�� �s�2-� Alternate Phone: �sZ� Z8/.-aS IO <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retainine Walls ❑ Temporarv Trailer <br /> General—User Defined Surchar�e General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—42"or Greater � Land Alteration ❑ Zoning Review <br /> General—User Detined Surchar�e General—User Defined General—User Detined <br /> ❑ Conmiercial—(Per UBC) �0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: � 550.00 (Ne�ds Slte P�an) <br /> General-User Detined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(t�eeds C.u.t'.) <br /> ❑ Tree Removal �iF� �..�. � �� � "�` /��1 �t--� �(:i. V, ����� L � <br /> General—User Defined ���� ��(��r'��,, \• <br /> *Within 0-75' -$30.00 �� j L ���� � �C �' �V� �IW� �l�� �'�l�� �� U!� <br /> I <br /> I herUy 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 be in acc rdance wit a�proved plan. <br /> ��S��S <br /> Applicant Date <br /> _,__ ....____ <br /> (Use[DeSned Peemit 3l18l04) <br />