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.,,.�► , �f��.G �,Uz��r �T' iv�,�rs•o� �.9�%c�.5���r-- <br /> ¢Q� City of Orono �.- ��t ��?' i=/'� FOR CITY USE ONLY �/ <br /> O, �� P.O.Boa 66 �� ^ �( ��� Date Received: S-2� Permit#/�}b 9'�JDO <br /> ( �� l 2750 Kelley Parkway <br /> � '1y��.~• ''/' Crystal Bay,MN 55323 7p <br /> �''�wl�riv��,��� (952)249-4600 Amount: $� C.U.P Filed. <br /> ��Og ,, n� <br /> (�'' 0` Approved By:�l.�l-T.Jc�J Site Plan: <br /> (QI�� �N�I,G. <br /> Recommends: A roval [� Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (Ail pennits must be approved by the Building Official andlor Zoning Department) <br /> Job Site/Owner Tnformation: <br /> --,; . _ - � _,._ � <br /> Site Address: ,�,� �j"'7 ��� �f�U�/�� �=�'�� <br /> � , � <br /> Owner: ������ U/�!(� � Mailing Address: <br /> City: �`�%.!L' Zip: �� �� ?� �'� <br /> Home Phone: Alte � � '�Cl-���L!� <br /> ��i� �,(r <br /> Contractor/Applicant Information: �((.2•� ��� <br /> � �� W � ?'l�'4 (='lr�G <br /> Contractor/App.:�CG ��-��" Cc <br /> ��Ji� <br /> Address: ��,` �� �� L:�- �v St �Z'Z z►-°!`8/Y�� _ __ <br /> City: �G��t ,�=t?/;'r� Zip: `' °"� i � Expiration Date: <br /> Phone: ��_`a`�:���' ,� �� ' Alternate Phone: � `�-� _ ' - �:�_ �-�`�,<v�,, <br /> TYPES OF USER DEFINED PERMITS � <br /> ❑ Stairway to Lake Retainin,.g_Walls ❑ Temporary Trailer <br /> General-User Defined Surcharge eneral-User Defined Surcharge General-User Defined <br /> *(Per UBC) * (Per UBC) � *$30.00 <br /> *Estimated Cost: $ *Estimated Cost:$'�,�CJv <br /> ❑ 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 /> * Estimated Cost: $ $50.00(Needs Site Plan) <br /> Generaf-User Defined ❑ 501�Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Re�noval <br /> General-User Defined <br /> * Within 0-75' -�30.00 <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code; that I understand this is not a permit and work is not to start without a permit; and that the <br /> «�ork will be iu accordape��vith the approved plan. <br /> -�- � , ,. __ <br /> -, <br /> / _�� t f���-�`` :�` `- ` ,_ W':c=:� <br /> Ap icant _ _ _ _ Date <br /> . . Re$et F�rm� � (UserAefmzdPe[mit3/i8l04) <br />