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p\ pity of Orono <br /> �' P. .Box 66 F , ONLY <br /> 4 t,. 2'50 Kelley Parkway D Received: <br /> �/ emit# <br /> a '4?� ' C ystal Bay,MN 55323 Ce ]!' <br /> ,4 (952)249-4600 <br /> Ctj Amount; C,U P Filed. <br /> Approved By - Site.Plan <br /> Recommends Approval 0 Dental ❑ <br /> PITY OF ORONO USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Buil ding Official and/or Zoning Department) <br /> • <br /> Job Site/Owner Information ' <br /> Site Address: 2-C✓ 4Y 0 012.e ,p 19-0to , > 35 p <br /> Owner: Mailing Address: 5 A <br /> City: L Jto LAIL Zip: 65 35Ip <br /> Home Phone: *1-'1'76'S(on Alternate Phone: 'to I2•R(a5•.9'$p1 <br /> 'O640-ctor/,�.Ap4444, izform0on µt k. a <br /> Contractor/App.: 111:4-15,9U)1,-;012. Contact Person: VI I j? D <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: i2. eilto •2( ( Alternate Phone: Cole•`:tto.S•R't p <br /> q;r <br /> :Ii ,.'f_ i 4W ';'' TY;P.ES OF.USER DEFINED I tt S ra'g±::-Vit:W;';044-.A.Ci. <br /> ❑ Stairway to Lake ❑ Retaining Walls <br /> ❑ Temporary Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) * (Per UBC) *530.00 <br /> *Estimated Co :$ *Estimated Cost: $ <br /> O Docks-42"or reater [Land Alteration ❑ Zoning Review <br /> General-User Defin d Surcharge Genl--User Defined General-User Defined <br /> ❑ Commercial (Per UBC) U0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cos :$ 550.00(Needs Site Plan) <br /> General-User Deftnld. ❑ 501+ Cubic Yards <br /> ❑ Residential- 1530.00 550.00(Needs C.U.P.) <br /> O Tree Removal 1 <br /> General-User Defined <br /> *Within 0-75' -5130.00 <br /> I herby apply for aI4Iser Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the wore 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 wibe in accor'ance with the approved plan. <br /> r <br /> 1 mar r / CoI I(a fvfb <br /> ppl i cant ;. .._ . ... .. .. Date . <br /> ''eset Form (Wei Defined Penni t3/18/4x) <br />