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¢�� City of Orono F C Y USE ONLY <br /> P.O.Box 66 Date Received: Permit# ( C� <br /> ��%�.�, � 2750KeIleyParktivay <br /> • � �i��,r�• � Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> ��'���N���y� (952)249-4600 � � <br /> sasoa <br /> Approved By: �V_ Site Plan: (, 'Z b•0'� <br /> Recommends: A roval [i] Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pemiits must Ue approved by the Building Officia]and/or Zoning Department) <br /> Job Site/Owner I�iforniation: <br /> Site Address: -�'�� �'��� �^ `-� �^� 'Q� <br /> Owner: ��,J ��\�u,,,,,, T .�'l� Mailing Address: 5�-t <br /> City: �'h� �,�-.� Zip: ��3 f��f <br /> Home Phone: � �z - g z 3 ���2 Alternate Phone: �l�� - Ze i —z z�� <br /> Cont�actor/ Applicant Information: . <br /> Contractor/App.: �/;,��� Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> �Stairway to Lake ❑ Retainin�ls ❑ Temporary Trailer <br /> General—User Defined 5urcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) � *(Per UBC) * $30.00 <br /> *Estimated Cost: $ `ZAc>o`L *Estimated Cost: $ <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Corrunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $SO.00 (Needs Site Plan) <br /> General—User Defined ❑ 501+CublC Yards <br /> ❑ Residential- $30.00 $SO.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Witlun 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 pemiit and work is not to start without a pemut;and that the work <br /> will be in accordance with the approved plan. <br /> �� �/�J /0�� <br /> Applicant Dat <br /> Rlser De6ned Pertni�3/1 RiOal <br />