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Cit of Orono <br /> U,j� Y FOR CITY USE ONLY <br /> P.O.Box 66 R 0 0 Date Received: Permit# Rp 9 7. <br /> al 2750 Kelley Parkway <br /> �i Crystal Bay,MN 55323 ID' <br /> Amount: $ C.U.P Filed: <br /> t <br /> Ah"i (952)249-4600 <br /> rsxos <br /> Approved By: Site Plan: <br /> Recommends: Ap roval [[( 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/Owner h-lformation: <br /> Site Address: �� �iL7� <br /> Owner: Mailing Address: YYL�— <br /> City: �f 0✓l O Zip: <br /> Home Phone: `7��p'"`/ � Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: �ti� 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 ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) *$30.00 <br /> *Estimated Cost:$ *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 *For 0-75'Zone-$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 /> J�J 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; t t work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Buildin e at I understand this is not a permit and work is not to start without a permit;and that the work <br /> will be c an w the approved plan. <br /> © <br /> Applicant Date <br /> (Usff Defined Permit 3118/04) <br />