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r • <br /> O¢'p City of Orono <br /> "O\ P.O.Box 66 FOR CITY.USE OM,Y <br /> ;.t. 2750 Kelley ParkwayDa 'Rtcerved Permit#t . 4 Crystal Bay,MN 55323 <br /> (952)249-4600 <br /> .41C481ca Amount: :$ C.U.P Filed <br /> Approved By I) <br /> O Site.Plan <br /> Recommends: Approval 0 Denial': <br /> CITY OF ORONO USER DEFINED/GENERAL PERMIT <br /> (All permits mustbe approved by the Buil ding Official and/or Zoning Department) <br /> rr <br /> ;Job'Site/Owner Iriformti:,'•on t <br /> Site Address: Z6.5-- <br /> inw9( 6y-c.i r /K'' <br /> _ r <br /> Owner: C7 <br /> c of ©fOK 0 Mailing Address: ,?o?( 6‘ Cyt siqf <br /> City: Zip: �333 <br /> Home Phone: '2-5W- 4/73-- 77'0 If Alternate Phone: 1.�� �76-��/ <br /> CoiMtraGtor/4ipplhcait1nfoxrnatronni4„: <br /> Contractor/App.: Contact Person: fOli `5*'F x1-iqq <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone:y <br /> /t:. ,r: ... .TYPES QF>:USERti.OVED',Pg6IITS t.,AV,Agi;_ g, 4 , r.« <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) *S30.00 <br /> *Estimated Cost:$ *Estimated Cost:$ <br /> ❑ Docks—42"or Greater Eand Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General-User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ® 500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost:S $50.00(Needs Site Plan) <br /> General-User Defined. ❑ 501+ Cubic Yards <br /> D Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * Within 0-75' -$30.00 oar_„ I 19, <br /> t P <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 be in a ordand,�•th th•; approved plan. <br /> - /P _ 8-/7- 495 <br /> Ap 1i ant Date <br /> leset Form (User Defined Permit 3/18!041 <br />