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Cit of Orono <br /> � �,O,� Y � �� ��USE ONLY <br /> � O O P.O.Box 66 Date Received: ' L� Permit# � J-- /ZJ��� <br /> �",L 2750 Kelley Parkway ' <br /> `li'i �?� �r <br /> � ���� `� Crystal Bay,MN 55323 e ��', Amount: $ �%a.�yQU.P Filed: <br /> 'ij ��y� (952)249-4600 ��� � � <br /> �'�+t�o$ , , . <br /> - Approved By: �� Site Plan: -�"(- <br /> Recommends: A roval 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: ���� ��-I �� � • <br /> Owner: -1-��•s`C' � �e/`���e�` �aMe2� Mailing Address: ��13� ���.�� <br /> City: �Jf2�/� Zip: ����U� <br /> � ���Home Phone: ���7� � �z — � � � Alternate Phone: <br /> Cont�•actor/Applicant Information: i <br /> /�--/ (�- <br /> Contractor/App.: Vc��l ����� ��� Contact Person: ' �_�.� <br /> Address: Z:�y� �n.,� �f , State License#: '���$3 (o� <br /> / � � <br /> City: �n� �/� Zip: SJ��p Expiration Date: �1 � z <br /> Phone: �J 2' �2!O� ��`�� x�� Alternate Phone: �]��-��3L-2y2"I <br /> � �h `° �� �, TYPES OF US�R D�FI�-ED°PERMITS ��i;,�� � T �' � ��� � <br /> [�Stairway to Lake ❑ Retainin Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) �.� *(Per UBC) * $30.00 <br /> *Estimated Cost: $ 1'Z��-{CN * Estimated Cost: $ <br /> ❑ Docks-One Time(tvo�-Lake Mt�) [�'Land Alteration -.�iq � ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined 7 `�� General—User Defined <br /> ❑ Commercial-(Per UBC) �0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+Cub1C YaTds <br /> ❑ Residential- $30.00 $50.00 (Needs c.u.P.) <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 wark is not to start without a permit;and that the wark <br /> will be in accar w' h the approved plan. <br /> _ ? <br /> Applicant � Date <br /> tUser Defincd Pamii 05/48f09} <br />