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i p City of Orono <br /> , �Ir FOR CITY USE ONLY /Z <br /> P.O.Boa 66 <br /> e, <br /> e. 2750 Kelley Parkway Date Received: Permit# <br /> vt � <br /> Crystal Bay,MN 55323 &ZD -7�} <br /> (952)249-4600 Amount: $ t'I C.U.P Filed: <br /> �l Approved By: Site PIan: 1 -2 ,07 <br /> Recommends: A22roval Denial ❑ <br /> V oNv`( (=trrAt <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job`Sife/Owner:Information <br /> Site Address: Z S AJ2ZK 9 46AF DR , <br /> Owner: pAu ISS l3 U� <br /> � Mailing Address: <br /> City: Zi <br /> .� p: <br /> Home Phone: !152, Z Alternate Phone: 9Sz. ®9• ©/8 <br /> Contractor/..Applicant`Information. <br /> Contractor/Arp.:_ a �IlXu&,, Com,/�M�ontact?erson: ) <br /> Address: �✓�J?T' ,� IW lfl[.,gpb G State License #: <br /> City: Zip: 5300Z Expiration Date: <br /> Phone: 69,le 3 g Alternate Phone: 2-4v L, 9 Z, f0 (e-.7 <br /> 1J _ <br /> TYPES_OF USER.DEFMED`PERMITS. ;. <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> (� General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> WJ * (Per UBC) *(Per UBC) * $30.00 <br /> *Estimated Cost: $ (o ', ... *Estimated Cost: $ <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 /> General—User Defined ❑ 501+Cubic Yards <br /> Z <br /> El Residential- $30.00 $50.00(Needs C.U.P.) S r <br /> ❑ Tree Removal <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 work <br /> will be in accordance with the approved plan. <br /> c.L s C�,- CA4 .S t_L.C. <br /> iV C d Ivy ?ZrID •a . <br /> nlicant Date <br />