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� ��t� of �ror�o <br /> � � , �onir�c� �errr��fi �4 �cca���� <br /> Mailing Address: Permit number: o�p/�—�� � 7 <br /> �.��o PO Box 66 Date received: <br /> Crystal Bay, MN 55323-0066 <br /> Escrow#and <br /> Street Address: amount: <br /> �, � 2750 Kelley Parkway <br /> ''S�, ` Orono, MN 55356 Permit Fee: <br /> G <br /> `�kFSH04� Fax: 952-249-4616 Approved by: <br /> Main: 952-249-4600 Notes: <br /> v�.ci.orona.mn.us <br /> This application form must be completed in full and all required information must be submitted. (P/ease prinf.) <br /> Job Site Address: �j,�QQ� �Q(�'� �R.�' �Q��(-e <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: I�t1'�2 3 1�1�1�1i(1 �P�� L�, _�/-�/PA� P�P,��(".Q�f1C� <br /> Phone: ��¢�-��- ���. Fax� <br /> Address: ��{-(,e0 ��� � NW �t4,h- City�Q�(�� ZIP• Fifo2�a-I <br /> Contact Person: �� ���, Contact s phone nu b _ 3 _ <br /> Email ����}������� Applicant is: Contractor Homeowner (Circle One) <br /> ��� <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): <br /> Mailing Address: ZIP: <br /> Email and/or Fax <br /> Oderall Project Description: <br /> --C�iecl�_ __ -- __ _ - _ _ _ ___ _ _ - - - � <br /> - __ - - _ _ — -- -- __ <br /> Box TYPE OF PERMIT <br /> collected when ermit is issuea <br /> Dock, Commercial $50+engineering review costs <br /> Escrow for erosion control and en ineerin review costs $2,000 <br /> Dock, Residential - Permanent dock on any lake or initial seasonal dock not on Lake $50+engineering review costs <br /> Minnetonka ermanent dock re uires CUP <br /> Hardcover Permit: Driveway, Patio, Sidewalk,etc.(New or Replacement) No charge <br /> Also re uires is a Minor or Ma or Land Alteration Permit <br /> Land Alteration, Major (grading, filling, or excavating) of more than 500 cubic yards $50 <br /> beyond the lakeshore setback OR more than 50 cubic yards within the lakeshore setback <br /> {also requires Conditional Use Permit) <br /> lReference: Citv Code Sections 78-967 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs As determined b CUP <br /> Land Alteration, Minor(grading,filling or excavating)of 51 to 500 cubic yards beyond the $50+engineering review costs <br /> lakeshore setback OR 50 cubic yards or less within the lakeshore setback <br /> lReference: Citv Code Sections 78-967 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs $2,000 <br /> Retaining Walls which exceed two feet in height above existing grade; or result in more $50+engineering review costs <br /> than 20 cubic yards of imported fill; or are located less than flve feet from the property line. <br /> Escrow for erosion control and engineering review costs $2,500 <br /> lReference: Citv Code Section 78-1405l5 1)1 <br /> Retaining Walls which measure more than four feet(from bottom of footings to top of wal!) <br /> require a building permit. Tiered retaining walls are considered one wall unless the walls <br /> are se arated b twice the hei ht of the lower wall. <br /> Stairway or Lifts to Lake(New or Replacement) IReference: C;tv Code Sections 78-12821 $50 +engineering review costs <br /> Escrow for erosion control and engineering review costs $2,000 <br /> Structure Permit for other structures 200 sf or less not requiring a building permit but $50+engineering review costs <br /> regulated by the zoning Code lReference: Citv Code Section 86-661 <br /> Escrow for erosion control and en ineerin review costs $2,500 <br /> Tree Removal or other vegetation removal within 75 feet of lakes No charge. <br /> Reference: Cf Code Section 78-1285 Pre-ins ection re uired. <br /> Tem ora Construction Office/Trailer associated with buildin ermit $30 <br /> Updated: May 2015 <br />