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V <br /> City of Orono <br /> Zoning Permit Application ^^�� ,, <br /> Mailing Address: Permit number: O 1-7-b I 2-ia <br /> v._001\1 PO Box 66 Date received: ' 91'/- 17 <br /> Crystal Bay, MN 55323-0066 <br /> Escrow#and t(� m. AZA67--01 Jn <br /> Street Address: amount: '�'t {,' "i <br /> 2750 Kelley Parkway <br /> y� Orono, MN 55356 Permit Fee: �l� <br /> l,1 c'Pf\* Approved by: <br /> kF s H O� Fax: 952-249-4616 <br /> Main: 952-249-4600 Notes: <br /> www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. (Please print.) <br /> Job Site Address: 'Pp OL7WI% 14641--e PO/ d WQ <br /> CONTRACTOR/APPLICANT INFORMATION: E <br /> Name: rJ l�_Vk U I( .)_, _p tCC( �-o E t LLooN <br /> Phone: (lp/Z)_07- Fax: ((0 c-/) � .-.5---/73+ _ <br /> Address: -2-7.D <br /> I r I�tJO Ci y: 4T, f� L-- ZIP: —si.40 <br /> Contact Person: I X99)3 Contact's phone nu •- / , y k <br /> Email *, i D ,t ,, ,_ a ( Applicant is: ontractor Homeowner (Circle One) <br /> f aro) <br /> PROPERTY OWNER I FORMATION: ( <br /> Name: (it-�R.(5 eq Z1N A)! 0 uT0 <br /> Phone (day): /i/7--) if f i+— 0/'''- <br /> Mailing Address: _ �4p O ULAD /.-0- 64.- U4'(-� R'() ZIP: . -S =7/Email and/or Fax C�E.e�Cil/lil, -1-na, -t�aD�,�(/�,�D D. , �,ryU <br /> Overall Project Description: ' A U/� <br /> Check TYPE OF PERMIT FEE <br /> Box collected when permit is issued <br /> Dock, Commercial $50+engineering review costs <br /> A,j J� Escrow for erosion control and engineering review costs $2,000 _ <br /> / Dock, Residential - Permanent dock on any lake or initial seasonal dock not on Lake $50+engineering review costs <br /> N l AMinnetonka(permanent dock requires CUP) <br /> VNoHardcover Permit: Driveway, Patio, Sidewalk,etc. (New or Replacement) <br /> charge <br /> Also requires is a Minor or Major Land Alteration Permit <br /> Land Alteration,Major(grading,filling,or excavating)of more than 500 cubic yards beyond $50 <br /> the lakeshore setback OR more than 50 cubic yards within the lakeshore setback (also <br /> N'K requires Conditional Use Permit) <br /> (Reference: City Code Sections 78-967, 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs As determined by CUP <br /> Land Alteration, Minor(grading, filling or excavating)of 51 to 500 cubic yards beyond the $50+engineering review costs <br /> lakeshore setback OR 50 cubic yards or less within the lakeshore setback <br /> N IIA (Reference: City Code Sections 78-967, 78-1247 and 78-12861 <br /> Escrow for erosion control and engineering review costs $2,000 <br /> Retaining Walls which exceed two feet in height above existing grade; or result in more $50+engineering review costs <br /> than 20 cubic yards of imported fill; or are located less than five feet from the property line. <br /> Escrow for erosion control and engineering review costs $2,500 <br /> N'1 (Reference: City Code Section 78-1405(5.1)1 <br /> f� Retaining Walls which measure more than four feet(from bottom of footings to top of wall) <br /> require a building permit.Tiered retaining walls are considered one wall unless the walls are <br /> separated by twice the height of the lower wall. <br /> rntStairway or Lifts to Lake(New or Replacement) (Reference: City Code Sections 78-12821 $50+engineering review costs <br /> "1 i't Escrow for erosion control and engineering review costs $2,000 <br /> Structure Permit for other structures 200 sf or less not requiring a building permit but $50+engineering review costs <br /> regulated by the zoning code(Reference: City Code Section 86-661 <br /> Escrow for erosion control and engineering review costs $2,500 <br /> Tree Removal or other vegetation removal within 75 feet of lakes No charge. <br /> (1\1W (Reference: City Code Section 78-12851 Pre-inspection required. <br /> Temporary Construction Office/Trailer(associated with building permit) $30 <br /> Updated: January 2017 <br />