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,��� City of Orono F CITY USE ONLY <br /> P.O.Box 66 Date Received: ��� Permit# � <br /> ��;,:.:.�. � 27�0 Kelley Parkway <br /> ` � �l�'�=��m- '� Crystal Bay,MN 55323 Amount: $ � � C.U.P Filed: <br /> �t 1,�1.:1�;:�,' � <br /> �'"u�;krJi":v3��,� (952)2a9-aGoO <br /> ��axog Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERI��IT <br /> (All pennits must be approved Uy thz Buildine Official and/or Zoning Departinent) <br /> Job Site/ Owner I�lforniation: <br /> Site Address: 1 —]L--� Qj 1�'C��T't-� =A�1� �j� <br /> Owner: .�oC`� v�l5 � �.� Mailing Address: ��e�1� <br /> City: �2C�1�0 Zip: <br /> Home Phone: �� ���-( (��-{ — �I 3��j Alternate Phone: <br /> Cont�•actor/Applicant I�lformation: <br /> . � ��������� �� �k�z <br /> Contractor/App.: U�P��� Contact Person: <br /> � 5��4 I <br /> Address: �-� �v cl,' �vc State License #: <br /> � <br /> City: ��,��� .�,.y� Zip: ���� Expiration Date: <br /> Phone:�Q�oZ--�(Q�"37.-2-� AlternatePhone: 7�J� - �79� 8�-5� <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surdiarge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General—User Detined Surcharoe General—User Defined General—User Detined <br /> ❑ Conunercial—(Per UBC) (�, 0-500 Cubic Yards *ForO-7S Zone-$30.00 <br /> *Estimated Cost: � SSO.00(Needs Site Plan) <br /> General—User Delined ❑ 501+Cubic Yards <br /> ❑ Residential- 530.00 $SO.00(Needs C.U.P.) <br /> ❑ Tree Removal N�fe O r� �rm�T+ MpUv�d ��d �C,' � i f� � l�LPi►15�� <br /> General—User Defined '��b�_Lr f� ��� � <br /> *Within 0-75' -$30.00 �� � `r TIJ ����� <br /> ..--- <br /> I herby apply for a User Defined Permit and I aclrnowledge 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 pernut;and that the work <br /> will be in accordance with the approved plan. <br /> Applicant Date <br /> v� ��� (User.Ik6ned Prnnit 3/1.8/04) <br />