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��`� City of Orono � �'Z�ID� F R CITY USE ONLY <br /> O¢ `r��� P.O.Box 66 Date Received: -2 -CYo Permit#yQd 9785 <br /> • y 2750 Kelley Parkway <br /> - �� 3Ety�f;+- � Crystal Bay,MN 5�323 �D <br /> ��' " t �� 952 249-4600 <br /> y��o�,s.� � � Amount: $ 5� � �C:U.P Filed:� <br /> ..__J/ <br /> Approved By:CIy��Site Plan: /U�iq <br /> / <br /> Recommends: A roval Denial ❑ <br /> Fn,rA� 7..rs� 2�y• w�e r.f D�'�e <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Offcial and/or Zoning Department) <br /> Job�Site/ Owner Information: ����� � � <br /> ; <br /> Site Address: . <br /> Owner: • Mailing Address:�y <br /> � ����� <br /> City: L���l r"�' ' Zip: S � <br /> Home Phone: Alternate Phone: lD�v7 ' 3j � ' ��� <br /> C tr tor/Appl' a Information: <br /> , L � � <br /> �J / � <br /> " Contractor p .: Cont t erson: � <br /> Address: ` . C I State License #: � , <br /> Cit � Zip: _S�d"/ Expiration Date: l 3 - � <br /> Phone: ��J� - ��7� -��� Alternate Phone: ��c�- � `«c3 7�c� <br /> � ; ' TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retainin Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge 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 ❑ 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.��(Needs Site Plan) <br /> General—User Defined ❑ SOI+CublC Yards <br /> ❑ Residential- $30.00 , $SOA (Needs . .P.) <br /> � �V�^ iX�:]LrC�C [�2'�' `,� <br /> ❑ Tree Removal � <br /> General—User Defined � � (/�(XiL1/ ������C� l > <br /> * Within 0-75' -�30.00 � � � <br /> J <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 confarmance with the Ordinances and Codes of the City and with the State <br /> Building ode;tha'I u erstand this is not a permit and work is not to start without a permit; and that the <br /> work il be in ac ord ce`ith the approved plan. <br /> � � - 6 <br /> Applicant �_ � t � Date � <br /> � �' �,� rvs«ne�ea�«�wi'�risroaj <br /> � Re'e or�n ����` <br /> �,73P.�.w..�'�.:: .�.,��[u.�"�.�k�e.r�1:< <br />