2004-P07998 - land alteration - Laserfiche WebLink

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� . O��O City of Orono FOR CITY USE ONLY P.O.Box 66 Date Received: PeRnit# q�,�, 2750 Kelley Parkway a 4j!��:`;- � Crystal Bay,MN 55323 Amounr. . $ C.U.P Filed: �A��o�o� 952 �49-4600 _ .(�'y ( )- Approved By: Site Plan: Recommends: A roval ❑ Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT (All pemiiu must be approved Uy the Building Official and/or Zoning Department) JoU Site/Owner Infornlation: Site Address: � � '� � �1�utcf; ��-} /�� '��._ Owner: �/� .�`�-� Mailing Address: ' City: ��a�' Zip: Home Phone: � S�� '�7�- ��7 Alteizzate Phone: Contractor/Applicant Information: Contractor/App.: Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Plione: TYPES OF USER DEFINED PERMITS ❑ Stairwav to Lake ❑ RetaininQ Walls ❑ Temporarv Trailer General-User Defined Surcharge General-User Defined Surcharge General-User Defined *(Per UBC) * (Per UBC) *$30.00 *Estimated Cost: $ *Estimated Cost: $ ❑ Docks—42"or Greater e Land Alteration ❑ Zoning Review General-User Defined Surcharge General-User Defined General-User Defined ❑ Commercial-(Per UBC) [.� 0-500 Cubic Yards *ForO-75'Zone-$30.00 *Estimated Cost: $ $50.00(Needs Site Plan) General-User Defined ❑ 501+Cubic Yards ❑ Residential- $30.00 $50.00(Needs C.U.P.) ❑ Tree Removal General-User Defined *Within 0-75'-$30.00 I herby apply for a User Defined Permit and I aclmowledge that the information above is complete and accurate; that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code;that I understand this is not a pernut and work is not to start without a pernut;and that the work will be in accordance with the approved plan. ��,�?P f%�----___ f'J-tym"_"�� 0 1�- Applicant Date .. cv�;�r�dr�:i�k�