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,��� City of Orono �pR-CI3'Y i�SE ONLY q <br /> � � P•O.Box 66 Date Receiusd:' �� 'Permit#��� / <br /> 2750 Kelley Pazkway <br /> � � � Crystal Bay,MN 55323 1�tnount:` � ��� �: �C.U.P���ed; � <br /> � (952)249-4600 ���, , <br /> Appro�etl�ys Site.�lan, <br /> Re�ommends A`�"io�al []: benial � ' <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: ���� <br /> � � � <br /> Owner: � � Mailing Address: s�'�`� <br /> c��: � ` � lp: 5 3�3�� <br /> Home Phone: �s�� y?3 -gb�� Alternate Phone: ��� '?y'-��l <br /> Contractor/App.: � � r Contact Person: <br /> �tJ <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ❑ Stairwav to Lake � Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surchazge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated ost: $��60� oa� � Ll� <br /> -�.,�'�^',��U%�'1Ja� Q�p/ � �,� <br /> ❑ Docks-One Time rnron-�ke Nttt�� ❑ Land Alteration J�� ^�' Zo i eview <br /> General—User Defined Surcharge General—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 ❑ 501+Cubic Yards <br /> ❑ Residenrial- $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 aclrnowledge 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 /> Bu' ding Code;that I understand this is not a permit and work is not to start without a permit;and that the work <br /> ' be in accord e with the approved plan. � <br /> ` <br /> � �— ��' �� <br /> Applicant Date <br />