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(---0.0-"A City of Orono `FOR,CITY'USE ONLY <br /> P.O.Box 66 �s <br /> Date Received: :55/57// 10 Permit#E Cei P4 <br /> 2750 Kelley Parkway <br /> i� Crystal Bay,MN 55323 <br /> Amount: $ - 'C[J P Filed: <br /> N, ,(95(952)249-4600 <br /> Approved B <br /> pp Y-' (61 ! Site Plan , e"'�'. <br /> Recommends tlppraval . Denial'❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> 1. C3 1'1' f_ c) ' rte.[ I l f ''Iy I ZC? <br /> z. � "amu ,.. <br /> r-1 <br /> Site Address: �(S 0(c. CA(Lis1-4 6144-1 Qd N • <br /> Owner: (YCJviO S c o ci(S Mailing Address: t ij S C td C rtp c- <br /> 3 (ze! 1 04, <br /> City: L_ovt CA Zip: Ss Zs Co <br /> Encl►►neer: J o hr1!4 4-li p 13,1u e S trnan <br /> Home Phone: AvldJASw> - -A- -. ° .SU-t f\SboC of ei Phone: -7C3 9-1.4- 1IZ, ! <br /> 7(03 - 54({- 0531 (c) <br /> Contractor/App.: AL) qkwe - / pAA.1k Contact Person: ,,,'t LGVd <br /> Address: 14B 5C.oc,cI. C.i) State License#: A/I/t <br /> City: ' ee . Zip: 553—N Expiration Date: <br /> Phone: c.SI. i-ti- 5 I OO 3 Alternate Phone: <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—One Time(Non-Lake Mtka) and Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial—(Per UBC) D1-500 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 /> "Tell n1S Cc a4 (r4wi <br /> ceevt\- <br /> ❑ Tree Removal "t' <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 accord nce with t e approved plan. <br /> 17! 30. to <br /> p ant Date <br /> (1lsctieefialiaaia tlsrt 8TU9) <br />