HomeMy WebLinkAbout2008-00361 - land alteration k i-
CITY OF ORONO PERMIT NO.: 2008-00361
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 11/06/2008
952 249-4600 FAX: 952 249-4616
ADDRESS 3635 TOGO RD
PIN : 17-117-23-34-0014
LEGAL DESC TOWNSITE OF LANGDON PARK
LOT 006 BLOCK 010
PERMIT TYPE USER DEFINED
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE LAND ALTERATION(0-500 CU YDS)
NOTE:
LAND ALTERATION PERMIT-0-500 CUBIC YARDS
APPLICANT ..
SCH
OMARY.
3635TOGO RD
LAND ALTERATION 50.00
TOTAL 50.00
WAYZATA,MN 55391
.OWNER...
SCHOMMER,MARY
3635 TOGO RD
WAYZATA,MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this type of work
shall be compied with whether or not specified herein.This permit will .
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due caus
Y'W /ti 0(pi 0 $
Applicant Permitee Signa-fu-re Date
I d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
' p City of Orono
,$ �t Ftp_t- 1,'�t"/Y�SE ONLY
or,
p P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway J
Crystal Bay,MN 55323
(952)249-4600 Amount: $ C.U.P Filed:
Approved By�V1-'<Site Flan:
Recommends: Approval40 Denial
CITY OF ORONO -USER DEFINED/GENERAL PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Job Site/Owner Information} r
Site Address: 363':5- / 0G d 60,40 (2-AdAZO CAUVI A46) ZIAI S5 3 V
—16 3 S T'a G o R 04-9
Owner: M41Z Y SC /f 0,^1x'1( Mailing Address: w+Yz-I,-T* ,I /
City: _0 12 0,'1/t) Zip:
Home Phone: qLZ - 4/71 7 z Alternate Phone:
Contractor/Applicant Information:
Contractor/App.: S (F/C- Contact Person:
Address: 3 G 3 S %Oe-a g aA- ' State License#: /y/Y-
City: 09 d,1V C) Zip: SS..?4/ Expiration Date:
Phone: �SZ- �/7/ �Z��' Alternate Phone:
TYPES OF USER DEFINED PERMITS
❑ Stairway to Lake ❑ Retainin Walls ❑ Temporary Trailer
General—User Defined Surcharge General—User Defined Surcharge General—User Defined
*(Per UBC) *(Per UBC) *$30.00
*Estimated Cost:$ *Estimated Cost:$
❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review
General-User Defined Surcharge General-User Defined General-User Defined
❑ Commercial-(Per UBC) 0-500 Cubic Yards *For 0-75'Zone-$30.00
*Estimated Cost:$ $50.00(Needs Site Plan)
General-User Defined ❑ 501+Cubic Yards
❑ Residential- $30.00 $50.00(Needs C U.P.)
❑ Tree Removal
General—User Defined
*Within 0-75'-$30.00
I herby apply for a User Defined Permit and I acknowledge that the information above is complete and
accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State
Building Code;that I understand this is not a permit and work is not to start without a permit; and that the
work will be in accordance with the approved plan.
a� /v .3/- d F-
Applicant Date
Reset Form
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