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O¢ O City of Orono ; ( � FO CITY USE ONLY <br /> �� P.O.Box 66 ��'r � � Date Received: � ^' •���'ermit# <br /> �, 2750 Kelley Parkway �I� �r �F �� (�Z9' � <br /> � 1 tv�, '' Crystal Bay,MN 55323 � <br /> �\��o�,�� (952)249-4600 I�� �OrCy���� Amount: $ ���� C.U.P Filed: <br /> ' �,�� Approved By:�'ki�� Site Plan: q t{2"Q(� <br /> l.,L� (�-f{nc.�1 <br /> � r ���j �r���,� Recommends: A roval Denial ❑ <br /> � I �''� CITY OF ORONO - USER DEFINED/GENERAL PERMIT ' �3 J .�S/ <br /> �1 (All pennits must be approved by the Building Official and/or Zoning Department) � <br /> Job Site/Owner Infoc-mation: <br /> Site Address: Z��`� M ���L�`'''�t"2� ����4� <br /> Owner: S��Y S�N�� °`� Mailing Address: <br /> City: Zip: <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: S!�Pt-f�-- � �,�1��[<�� Contact Person: 2��— (�A�Y� <br /> ,P>�� �a�S <br /> Address: -r'I¢�t ��-�-STar� �va-t-� State License #: ��� <br /> City: �a��' ���'����� Zip: �'�347 Expiration Date: <br /> Phone: ��2" y�'3 -���Z � Alternate Phone: (0�2 —�"7o--Zz`,� <br /> �-' TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwa�to Lake ,�Retaining Walls ❑ Temporarv 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: $zU�o�.�'°' <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zonint 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: $ $50.00(Needs Site Plan) <br /> Genera]-User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- �30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <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 /> Buildin�Code; that I understand this is not a permit and work is not to start without a permit; and that the <br /> w wi11 be in accor ance with the approved plan. <br /> e ! _-7 _bCv <br /> Applicant , __ Date <br /> . .. .. ReSe,t F�rm (UserDefinedPetmit3/18/04) <br />