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� � � � City of Orono .� Zoning Permit �pplication Mailing Address: Permit number: (�7��G�� ��0 PO Box 66 Crystal Bay, MN 55323-0066 Date received: �2 Z�7 Escrow#and � � Street Address: amount: �� y'v'�'e 2750 Kelley Parkway S. 1 Orono, MN 55356 Permit Fee: .� � 4�'— � � G F, Approved by: �kFSH�� Fax: 952-249-4616 Main: 952-249-4600 Notes: � www.ci.orono.mn.us �, This application form must be completed in full and all required information must be submitted. 1 se print.) Job Site Address: 1095 Ferndale Road West CONTRACTOR/APPLICANT INFORMATION: Name: Welch Forsman Associates Inc Phone: 612-827-4455 (o) Fax: Address: 6026 Pillsbury Ave So City:Minneapolis ZIP: 55419 Contact Person: Don Forsman ContacYs phone number 612-221-0842 (c) Email don@welchforsman.com Applicant is: Contractor Homeowner (Circle One) PROPERTY OWNER INFORMATION: Name: Bill Toles Phone (day): 952-240-2100 Mailing Address: 2510 Crescent Ridqe Drive, Minnetonka MN ZIP: 55305 Email and/or Fax wtoles1041 @aol.com Overall Project Description: Site Grading in preparation for construction of a new residence CBoXk TYPE OF PERMIT collected whenE ermit is issued Dock, Commercial $50+engineering review costs Escrow for erosion control and en ineerin review costs $2,000 Dock, Residential — Permanent dock on any lake or initial seasonal dock not on Lake $50+engineering review costs Minnetonka ermanent dock re uires CUP Hardcover Permit: Driveway, Patio, Sidewalk,etc. (New or Replacement) No charge Also requires is a Minor or Ma'or Land Alteration Permit Land Alteration,Major(grading,filling,or excavating)of more than 500 cubic yards beyond $50 X the lakeshore setback OR more than 50 cubic yards within the lakeshore setback (also requires Conditional Use Permit) (Reference: Citv Code Sections 78-967. 78-1247 and 78-12861 Escrow for erosion control and engineering review costs As determined b CUP Land Alteration, Minor(grading, filling or excavating)of 51 to 500 cubic yards beyond the $50+engineering review costs lakeshore setback OR 50 cubic yards or less within the lakeshore setback (Reference: Citv Code Sections 78-967, 78-1247 and 78-12861 Escrow for erosion control and engineering review costs $2,000 Retaining Walls which exceed two feet in height above existing grade; or result in more $50+engineering review costs than 20 cubic yards of imported fill; or are located less than five feet from the property line. Escrow for erosion control and engineering review costs $2,500 (Reference: Citv Code Section 78-1405(5.111 Retaining Walls which measure more than four feet(from bottom of footings to top of wall) require a building permit.Tiered retaining walls are considered one wall unless the walls are se arated b twice the hei ht of the lower wall. Stairway or Lifts to Lake(New or Replacement) (Reference: Citv Code Sections 78-12821 $50+engineering review costs Escrow for erosion control and engineering review costs $2,000 Structure Permit for other structures 200 sf or less not requiring a building permit but $50+engineering review costs regulated by the zoning code(Reference: Citv Code Section 86-661 Escrow for erosion control and engineering review costs $2,500 Tree Removal or other vegetation removal within 75 feet of lakes No charge. [Reference: Citv Code Section 78-12851 P�e-InspeC � Temporar Construction Office/Trailer associated with buildin permit $30 MAY 2 2 2017 Updated: January 2017 CITY O�L�RONCy