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UCity of Orono FOR CITY USE ONLY 3� <br /> Box 66 P.O. <br /> 0- 0 <br /> Date Received: 3 5 10 Permit# ��` <br /> 2750 Kelley Parkway <br /> a ,> Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> (952)249-4600 <br /> $ D« <br /> Approved By: �'_/[ Site Plan: <br /> �" Iv Recommends: Approval [ Denial❑ <br /> Or- J-e t 55vte/ C 7 <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 Information:` <br /> Site Address: 5c� s S}-n <br /> Owner: OYCwlC) SCC 0 S Mailing Address: S C)�a C <br /> 3 r-*,j Rel �✓ <br /> City: _Cwt.ct �A to— Zip: SS 3ls <br /> Cncj►►ne2r: J U hn# 4 iA4-1 1�u e S wlAh <br /> Home Phone: A#erng Phone: -7(,o3- s,-fq- j I z q \\ <br /> s44- 0531 <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS j <br /> ❑ Stairway to Lake ❑ Retaininiz 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-One Time(Non-Lake Mtka) 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 /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> PAY kt vl . (JYtu lvtI PO-4 22 co 1-%'tv-61 v\ <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 /> Applicant Date <br /> (User Defined Pemvt 05103/09) <br />