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� <br /> • �g��O City of Orono FOR CITY USE ONLY <br /> � P.O.Box 66 Date Received: Permit!f <br /> ��,,,., , 2750 Kelley Parkway <br /> � <br /> � i!`���'�* � Crystal Bay,MN 55323 <br /> �,�;%o� (952)249-4600 Amount: � C.U.P Filed: <br /> Approved By:�6• MtP6-f s Srt P�an: ��_4 �e��o <br /> GVD/LK STA2� w�� ,P� `�,�,,� <br /> Recommends: A roval Denial '� <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT ��"'�� <br /> , <br /> (All permits must be approved by the Buiiding Official andlor Zoning Department) <br /> -�. <br /> Job Site/�wner Information: <br /> . <br /> Site Address: ��31 N����-�1 A-��M D��v� <br /> Owner: �l� ��"�e���, Mailing Address: <br /> c�r�: ��oY1D z�p: '��31�'� <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> . <br /> �ontractor/A .: �) �D� � �b�on a t Person: 1�Q-���Oc,�,�e2 <br /> PP �!�� <br /> Address: ���b ��I In���1(� �1��V� State License#: (����y�� <br /> Sv���t25 <br /> City: _l I�� Zip:�_��P Expiration Date: <br /> Phone: �cJ�'��'���'�.� Alternate Phone: �d�2'���"rJ?J72- <br /> TYPES OF USER DEFINED PERNIITS <br /> irwa t Lake �3� ❑ Retainin�?Walls ❑ Temporary Trailer <br /> Gene — er med Surcharge General—User Defined Surcharge General—User Defined <br /> R��It�t. * . — � *(Per UBC) *$30.00 <br /> J�_��Q 1�� * s mated • $�d/ *Estimated Cost:$ <br /> ��� <br /> S� ❑ Docks–42"or Greater �Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial–(Per UBC) ,�'0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * EstimBted Cost:$ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 501+CubIC Ya['ds <br /> ❑ Residential- 530.00 $50.00(Neeas c.tr.P.) <br /> I' ..:----r-----'—.-,.''"—���`�1 <br /> + General—User Defiaed----—�-'� <br /> '�*�11�0=7�=�&8� <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 accordance with the approved plan. <br /> �'Yl�t Q cv `�.�,-�-�� - - �I I� �b(� <br /> Applicant Date <br /> . (Usa Defined Perntit 3/18/04) <br />