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¢0 City of Orono FOR CITY USE ONLY <br /> O 0 P.O.Box 66 /) Date Received: W'7/v : Permit#,l �� <br /> 2750 Kelley Parkway t ri T <br /> ` x Crystal Bay,NN 55323 <br /> r• (952)249-4600 Amoum:L a CIL Flied: <br /> Approved By: Q�ite Plan: �-/t •01 <br /> Recommends: Approval�---' Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site i Owner information: <br /> Site Address: 581 North Stream Rd <br /> Owner: Janice and David Larson Mailing Address: 581 North Stream Rd <br /> Orono 55391 <br /> City: Zip: <br /> Home Phone: (952)473-0496 Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: Dynamic Design Landscapir Contact Person: Keith Bode <br /> Address: 907 Linden St S#2 State License#: 20102659 <br /> City: Northfield Zip: 55057 Expiration Date: 12/31/07 <br /> Phone: (507) 581-3010 Alternate Phone: 507-645-5038 <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake © Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharee General—User Defined Surcharse General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ 15,00015 <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ ZoninQ,Review <br /> General—User Detmed Surcharge General—User Defined GCneral—User Defi.ied <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *For 0-75'Zane-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General—User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <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 linderstard this is not a permit and work is not to start without a permit; and that the <br /> work will be rd ��th proved plan. <br /> Apnlicant Date <br /> Reset Form (User DefimdPermit 3/18/041 <br />