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, �,��yro �{ i ��.{i;;.`J' !-C�� ��`'� e <br /> City of Orono �� �� <br /> P.O.Box 66 � �'� <br /> 2750 Kelley Parkway ' ``� <br /> Crystal Bay,MN 55323 ` <br /> (952)249-4600 <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Site Address: 12�0 Loma Linda Ave Mound MN 55364 <br /> Owner: Donald R. &Carolyn E. Udell Mailing Address: 1210 Loma Linda Ave <br /> City: Orono Zlp: 55364 <br /> Home Phone: 952-471-8688 Alternate Phone: 952-926-9266 <br /> Contractor/App.: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ❑ Stairwa�to Lake ❑ Retainin� ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Detined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *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 /> * Estlmated 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 �j p/I/Go��� �"Z5'"'�'`� �'vM�CJ d�`0' <br /> General—User Defined �0 <br /> * W ithin 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 permit; and that the <br /> work will be in accordance with the approved plan. <br /> ����;�� ���"-�%' � �s/�� <br /> Applicant Date <br /> Reset Form <br />