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• . oA,, City of Orono SE ONLY <br /> y P.O.Box 66 .�Q <br /> /O, eh Datelleceived. Perrriit <br /> Sti,;.. 2750 Kelley Parkway A.f I llet <br /> • "? h t Crystal Bay,MN 55323 '—" <br /> \* ri5AN C (952)249-4600 „ ?,3(f C <br /> o� Amount: $ ' C.U.P Filed: �J7.124> <br /> �/— J 1 {13, <br /> Approv y, Site Plan: c.9 Z4'/QC/ <br /> Recommends: Approval Denial 0 . <br /> CITY OF ORONO USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Buil ding Official and/or Zoning Department) <br /> ::lb b -Site/Owner Information <br /> Site Address: 75 5 o t G C 4th, i � QOAc N 0441 <br /> o) Owner: 1(3rC/vlo COO S Mailing Address: <br /> of City: Zip: <br /> Home Phone: Alternate Phone: <br /> w <br /> ;;'Contractor/Appltc•'a rt Information ,A��; <br /> j Contractor/App.: i(--.-_ ;-( eli—a/--contact Person: <br /> uu <br /> 7,-...., y Address: "C�("D all c-'---0 w btz State License#: <br /> City: 1%1,e:76 /4,-0-Zip: -C.--C-7 Y U Expiration Date: <br /> L <br /> Phone: �� '�l�� ��� 2-� Alternate Phone: <br /> 4 '- 5 tr:- .'- iE t <br /> ❑ Stairway to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> \��\S *(Per UBC) *(Per UBC) *S30.00 <br /> J *Estimated Cost:$ *Estimated Cost:$ <br /> c..„, ❑ Docks-42"or Greater ❑ Land Alteration <br /> ❑ Zoning Review <br /> ----- C.i 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 (x501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> S�� <br /> ❑ Tree Removal rep/q-ce-rg 5 t vYi4 Ce- /v4c IC cv� t+1 K S S c/rt v., <br /> General—User Defined <br /> S fl4cl t LAN' he(c(?r, O4ss (-�%n4 I c of gVA-CS <br /> •.....L. * Within 0-75' -$30.00 ' C (Z Opel f3�'IP/► 01- S Clt v _i c�/ <br /> e KC2_Ss VOACa-y,, I <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> k. 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 /> wo • 1 be in accor nce with the approved plan. <br /> Applicant _. <br /> .. l C Date <br /> Reset f orm <br /> (User Defined Penni t3118/W) <br />