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C/"r �,�0 <br /> ��`'� Cit of Orono � <br /> �{,O,� Y � FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: �. 1r Permit# � <br /> � �+�,qt,., � 2750 Kelley Parkway � J l j — �' `f��yD <br /> � ��;�'°�-� Crystal Bay,MN 55323 <br /> 00 <br /> • ��r f,r� (952)249-4600 Amount: $�_ C.U.P Filed: � <br /> �:�. <br /> Approved By:��� Site Vlan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (i111 permits must be appro��ed by the Building Official and/or Zoning Department) <br /> Job Site�/Owner Information: ���� � <br /> � <br /> Site Address: ���� �1.�/l� �i�� �i�'���� <br /> � G �/ J ,/� �/ <br /> Owner: /`--/L�r�- �(/���/`�7 �7/�/1/ID/�il ing Address: /7� �l��C O.� <br /> City: �lD�`�G� Zip: �J��� <br /> Home Phone: _���f ���� 7��� Alternate Phone: 4��� - /��"���� <br /> Contractor/Applicant Information: � <br /> Contractor/App.: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINEll PERMITS � <br /> ❑ Stairwav to Lake ❑ Retainin Walis ❑ 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 g] Land Alteration ❑ Zonin�Review <br /> General–User Defined Surcharge General–User Defined General–User Defined <br /> ❑ Commercial—(Per UBC) �. 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> �Estimated Cost: $ $50.00(Needs Site Plan) <br /> General–User Defined � <br /> ❑ Residential- $30.00 �SO:Off'�1eec7-s�ffP�- <br /> ❑ Tree Removal <br /> General–User Defined <br /> * Within 0-75' -$30.00 <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 /> wor 'ill be in accordance ith the approved plan. <br /> � � �1 �� -�_Dl� <br /> Applicant �r Date <br /> ' Reset Form �������i�� <br /> ���� <br />