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O�OG City of Orono FOR C USE ONLY <br /> P.O.Box 66 Date Received: Zj3 Permit# zJ1 <br /> 2750 Kelley Parkway <br /> ''< Crystal Bay,MN 55323 <br /> (952)249-4600 Amount; $ C.U.P Filed: <br /> Approved By: Site Plan: <br /> Recommends: Approval ❑ Denial <br /> CITY OF ORONO-USER DEFINED/GENERAL PERMIT T 6 C-AA 50 <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> EV, <br /> Site Address: _ 3 5;0 5' 14,)0& <br /> Owner: J 'PUS G N-�L Mailing Address: 5s7m <br /> City: n>7 Zip: �� 3 <br /> Home Phone: 6 1 Alternate Phone: <br /> Contractor/App.: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> g I <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) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks—42"or Greater Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined 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+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal G <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 /> work will be in accordance with the approved plan. <br /> 'Appli t Date <br />