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4 f <br /> o% City of Orono FOR CITY USE ONLY-ht'UO(..1, <br /> /y <br /> P.O.Box 66 Date Received: 1/1-22;--61 Permit <br /> +;,, 2750 Kelley Parkway <br /> tri .lr <br /> f � <br /> C. Crystal Bay,MN 55323 Amount: $ C.U.P Filed: <br /> '4 ptyo (952)249-4600 <br /> .4 .__11,,,,1",. <br /> es <br /> Approved By: ^r'T-(C •Site Plan: /Z'1-0/ <br /> Recommends: Approval fr 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: 153 0 0 Z 4---4-1A JJ 134.29(44 p(o <br /> Owner: JEFF /0 PP CL-8AJS40k Mailing Address: /23 OO feocc.C11,,1,oy Ra- <br /> City: 1''\(-.Ik-Fr'Zll.-JkA Zip: SS-3 OS <br /> Home Phone: SZ— S'L( —W2_5— <br /> Alternate Phone: .6,/2....-ZJ 1—77 Ye <br /> Contractor/Applicant Information: <br /> Contractor/App.: fz- 1,O3 1.1/4j1�i-.1"L. COO <br /> dontact Person: LOU In 1C---12-70_S <br /> Address: h34114 SKI ()WO' State License#: L—f 7 <br /> City: RCVS/0►�- Zip: -J 3 3 1 Expiration Date: 47YOS-- <br /> , <br /> Phone: ciSZ-- b/ -- 43 UAlternate Phone: (0/2--3 0- 3 YU <br /> 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 /> ❑ Docks-42"or Greater [ ] Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ig 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 <br /> General-User Defined <br /> *Within 0-75' -$30.00 <br /> erb - .ply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate; .t the work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building 5C.•e;that I understand this is not a permit and work is not to start without a permit;and that the work <br /> will - a. ordance with the appro -d plan. <br /> //frz/ 7/ <br /> •,,,,K cant Date <br /> (User refined Pen*;3(18(04) <br />