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1 ¢OA,, City of Orono <br /> FOR CITY.:USE ONLY <br /> e 0 0 P.O.Box 66 Date-Received: . Perrriit <br /> s . 2750 Kelley Parkway <br /> le Crystal Bay,MN 55323 <br /> (952)249-4600 <br /> Amount it. C..UP Filed: <br /> APp�'vBy Site Plan <br /> Recommends: Approvals Denial 0 . <br /> CITY OF ORONO USER DEFINED/GENERAL PERMIT <br /> t.(All permits must be approved by the Buil ding Official and/or Zoning Department) <br /> Job'Pe.;./Owner Information ' ' <br /> D ki <br /> cohd 1 0vl <br /> Site Address: 6 50 ©k d C YLtS\-y l g°AiKO p4 y , <br /> Owner: �`� (0,1,..,:,,s, �, 'Mailing Address: S O So-) t Q}�S�'. S : 36p <br /> City: tett �r��-(�o`� Zi SS 9 o `S <br /> P: <br /> Home Phone: (o a.— G\7, '`'(OOU Alternate Phone: G k --Lk ck)--Li C2 '39 <br /> Contractor -Applicant-lrforrnntton' , {->i}� <br /> Contractor/App.: `(N CG4•-•eo-e 1-eS (.)S► ntact Person: f j.2-4-• "A-,e_-r- <br /> % <br /> Address: 50 Sou ^ -0 - • 5"l 3°O <br /> State License#: <br /> City: ti`'ti p S• Zip: 6 S403 3 Expiration Date: <br /> Phone: f ,.....`{q ,'Li©O U Alternate Phone: (ak a'-Mqa -Y(. . ct <br /> u...at .. g,4.r TYPE$OFTSERDEIVED P�R11�IIT5`, :` '-�r���6 . t4, *.4%6 <br /> E 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 /> 0 Docks—42"or Greater [ anc*A' ration <br /> 0 Zoning Rev w <br /> General-User Defined Surcharge General-User Wiined General-User dried t <br /> ❑ Commercial—(Per UBC) ❑ 0S00 Cubic Yards <br /> *For O-75'Zone-$30.00 <br /> *Estimated Cost: S $5.000(Needs Site Plan) <br /> General-User Defined ft 0 5011- Cubic Yards 1:'"` <br /> ❑ Residential- £30.00 £50.00(Needs C.U.P.) tt <br /> 0 Tree Removal ', G t k n Ole!e CA vt-t'3 <br /> General-User Defined , r, <br /> * Within 0-75' -S30.00 1110..0� hU1�l <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 /> 1v_z_1z __ 1 1 1 ' .(N I O . <br /> Applicant , . ..... Date <br /> Rese Form (Lisa De 3/18/04 I <br />