Laserfiche WebLink
ti <br /> . <br /> ,�0� City of Orono FOR ITY USE ONLY ��5 � <br /> � � P.O.Box 66 Date Received:��l � Permit# �UlJ�d �� <br /> a�,t 2750 Kelley Parkway <br /> � ��'����- Crystal Bay,MN 55323 Amount: $ GU.P Filed: <br /> '��i��+r��y�� (952)249-4600 <br /> aB�O$ Approved By: '� Site Plan: <br /> y,j��� Recommends: A roval Denial ❑ <br /> 11 <br /> /Ud �Ov�(oJ� ���'�� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Offieial and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: �300 �O�`^`� L'�K� .�'v'� <br /> Owner: �asD� �uGS c�w,wh Mailing Address: /30U Low� L�'�e�a A-��e <br /> City: (�!''G h D Zip: ,��► <br /> HomePhone: �o�7`'Z 3g'— L,/�fS7 AlternatePhone: <br /> Contraetor/Applicant Information: <br /> Contractor/App.: (7(N ►�.�C� Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES UF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retainin� ❑ Temparary 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-One Time(tvon-�ke Ntcka) �Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge T � ,G�en,�+�al—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) �0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 5�1+CUb1C YBTCIS <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 Co , art I erstand this is not a permit and wark is not to start without a permit;and that the work <br /> will be i cc da ith the approved plan. <br /> /Z-3- a y <br /> Ap �cant Date <br /> (Us«vesuect i�emut osiosrc�9� <br />