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a �0� City of Orono FOR CITY USE ONLY <br /> 0, 0 P.O.Box 66 Date Received: —Zy"o� Permit# <br /> �i;,:,>.�,. 27�0 Kelley Parkway <br /> a '�1''''���r'�� '� C s�al Ba ,MN 55323 <br /> ,y �,y;,{,;;;�- �, rY Y Amoun[: $ C.U.P Filed: <br /> `� �"�vi�;'���,� (952)249-4600 `' ,/ o <br /> �"�saxo� APproved By: �%y��aSite Plan:�-2�- � <br /> / <br /> 2econunends: A roval,� Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERIVIIT <br /> (All pennits must Ue approved by tlie Building Official and/or Zonin�Department) <br /> Job Site/Owner I�iforniation: <br /> Site Address: ��,� S �Gt/�,� �,�� v <' <br /> Owner: ��� /,'�d/�7`��S��� Mailing Address: �ssf� .//.��,�z��v�E:�� �i�. <br /> City: �T t� ^ � 6� � Zip: �S >� � �� <br /> Home Phone: f �� � � �- �6� �� � Alten7ate Phone: � ��' �� � ��" � Y� � <br /> Conh-actor/Applicant I�iforniation: -� /�� <br /> � 5 ����f <br /> Coiztractor/App.: �� ��dt�� �'S� c� !?��� � � <br /> Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake ❑ Retainin�Walls ❑ Temporarv Trailer <br /> General-User Defined Surcharge General-User Defined Surdiarge General-User Defined <br /> *(Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks—42" or Greater � Land Alteration A►01°��� ❑ Zoning Review <br /> General-User Dzf ned Surcharge General-User Detined General-User Detined <br /> ❑ Conunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7S Zoue-$30.00 <br /> * Estimated Cost: $ �SSO.00 (Needs$ite Plan) <br /> General-User Detined ❑ 501+Cubic YaTds <br /> ❑ Residential- �30.00 $50.00(Needs C.U.P.) <br /> /� Tree Removal �� - <br /> rw�-'�' <br /> �� General-UserDefned �'^� �� SCP�''M-� �'�- <br /> *Within 0-75' -$30.00 � �1�f _'� <br /> VJ <br /> I herby apply for a User Defined Perniit and I aclmowledge 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 pezznit and work is not to start without a pemut;and that the work <br /> will be in accordance with the approved plan. <br /> ' �`�� - :� � y-�� <br /> Ap 'cant Date <br /> , <br /> (User pofined Pecarit.3lt SlOa) <br />