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����� CityofOrono FO�SEONLY d���' <br /> P.O.Box 66 �J/O — <br /> Date Received: � Permit# 4� <br /> • � 2750 Kelley Parkway <br /> a �� �" �� Crystal Bay,MN 55323 <br /> 'A� a n <br /> �� ����� (952)249-4600 Amount: $ C.U.P Filed: <br /> Approved By: �� Site Plan: �,� ��/ <br /> 1� �.l C�� <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT � ��(� Qfi�%f'Uyy� <br /> (All permi(s must be approvcd bv thc Building Ofticial and/or Zonin�Dcpartment) <br /> Job Site/Owner I►�formation: <br /> Site Address: 1331 North Arm Drive <br /> Owner: Jim Peterson Mailing Address: 11027 Bell Oaks Estate <br /> Cit Eden Prairie Zi 55347 <br /> Y� p� <br /> Home Phone: �612) 308-2665 Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/A Concept Landscaping Jim Smith <br /> pp.: Contact Person: <br /> Address: 3153 Priest Lane State License #: 20580661 <br /> City: Mound Zip: 55364 Expiration Date: 03/31/12 <br /> Phone: �952)472-4118 Alternate Phone: �� �l ` '750- �37� ( ��1� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retaining Walls � Temporarv Trailer <br /> General–User Defined Surcharge General–User Defined Surcharge General–User De�ned <br /> * (Per UBC) *(Per UBC) �$30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks-One Time�N�„-�ake narka� ❑✓ Land Alteration ❑ Zonin� Review <br /> General–User Defined Surcharge General–User Defined General–User Defined <br /> ❑ Commercial-(Per UBC) B 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> � Estimated Cost: $ $50.00(Needs Site Plan) <br /> General–Uscr Detined � S�l+CUbIC YaCdS <br /> ❑ Residential- $30.00 $50.00(Needs Cu.P.) <br /> � Tree Removal <br /> General–User Detined <br /> * Within 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 /> Building Code; that I understand this is not a permit and work is not to start without a permit; and that the <br /> work will be in rdance with the aperoved plan. <br /> .�� <br /> (o - 7 - I a <br /> Applicant Date <br /> Reset Form a�" "�� <br />