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• o City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: Permit <br /> 2750 Kelley Parkway <br /> i ,'• iF Crystal Bay,MN 55323 <br /> ,, ` (952)249-4600 Amount: $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: Approval ❑ Denial <br /> CITY OF ORONO-USER DEFINED/GENERAL PERWT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Jab Site fi Owner informations <br /> Site Address: 685 Old Crystal Bay Road <br /> Owner: Orono Public Schools Mailing Address: 685 Old Crystal Bay Rd. <br /> City: Long Lake Zip. 55356 <br /> Home Phone: Alternate Phone: <br /> t mtractor/Applicant Infos€ Cation: <br /> Contractor/App.: Contact Person:Minnesota Roadways Co. Tom Underdahl <br /> Address: 4370 Valley Indust. Blvd. So. State License#: N/A <br /> City: Shakopee Zip. 55379 Expiration Date: <br /> Phone: (952)496-2651 Alternate Phone: <br /> TYPESOF USER DEFRAW � " ✓ <br /> ❑ Stairwav 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—One Time(von-Lake Mtka) ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) 8 0-500 Cubic Yards *For0-75'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 /> ❑ 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 <br /> work will be in accordance with the approved plan. <br /> 04/16/10 <br /> Applicant Date <br /> lRB>Fttl t of m tt r t epi 05ma j <br />