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O¢0�� City of Orono FQ CITY SE ONLY P.O.Box 66 Date Received: �5"t"`�_U(�ermit# 2750 Kelley Parkway � Crystal Bay,MN 55323 �pi �,� (952)249-4600 Amount: $ C.U.P Filad: aicsaor Approved By: Site Plan: Recommends: A roval ❑ Denial CITY OF ORONO- USER DEFINED/GENERAL PERMIT (All pern�its must be approved by the Building Official and/or Zoning Department) Job Site/Owner Information: Site Address: �`75 OiZry °iZ� � � i�� Owner: ��«o ��Sai✓ Mailing Address: ��- c�ry: ��z��vt� z�p: ss'3G y Home Phone: ��.a-�1'70? `G��-� Alternate Phone: �S'.�"�3S" ��a Contractor/Applicant Information: Contractor/App.:_T,A 5 A 3d vN Contact Person: Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: TYPES OF USER DEFINED PERMITS ❑ Stairway to Lake ❑ Retainin W�alls ❑ Temporary Trailer General—User Defined Surchazge General—User Defined Surcharge General—User Defined *(Per UBC) *(Per UBC) *$30.00 *Estimated Cost:$ *Estimated Cost:$ ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zonin�Review General—User Defined Surchazge General—User Defined Genera]—User Defined ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zone-$30.00 *EsNmated Cost:$ $50.00(Needs Site Plan) General—User Defined ❑ 501+Cubic Yards ❑ Residential- $30.00 $50.00(t�eeds C.v.P.) ""�Tree Removal ✓ General—User Defined *Within 0-75'-$30.00 I herby apply for a User Defined Permit and I acknowledge that the information above is complete and accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State Building Code; that I understand this is not a permit and work is not to start without a permit; and that the work will be in accordapce with the approved plan. /� �'��/!�� a Applicant Date Reset Form N�D�ned Pem�it 3/18/04)