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,g,off\ City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 <br /> �, Q Date Received: Permit# <br /> 4A,.,, 2750 Kelley Parkway <br /> ' i i,�'�s!?- ,. Crystal Bay,MN 55323 <br /> e o o (952)249-4600 Amount: $ CU.?Filed: <br /> Approved By: Site Plan: <br /> Recommends: Approval ❑ Denial ❑ <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: 5-55- 3--- --X:7' .--.7,`" ...C.,*(.' //3:17- ,c/ <br /> Owner: f v/,eeryy,-may, Mailing Address: 5-,5-57 0,Cci5/S /,,?..7� <br /> City: I'D/70 Zip: S-5-3'S- e <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information <br /> Contractor/App.: 57.14 'vic--v--- Contact Person: .//egie/i-e" <br /> Address: /0 Z 7. 49vI A.) State License #: D Z69 95- 54 <br /> City: 4/yIDU Zip: c$'V7 Expiration Date: <br /> Phone: 73/?-,y Z yAlternate Phone: 7I'3-2 S'c -fZ 7/ <br /> 7/ ? Z8(i, 8323 <br /> !I:4, TYPES OF USER DEFINED PERMITS' <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 /> E Docks-42"or Greater Z Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) rA 0-500 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 /> ❑ Tree Removal �Ur� e O(N <br /> General-User Defined l <br /> * Within 0-75' -$30.00 c2 (Ott - ) l D <br /> 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 b ' ordan- with the approved plan. <br /> -� <br /> . .,-- %%i- "i/' 7 <br /> pplicant Date <br /> Reset Form (User DefvdPermit 3/15/04) <br />