HomeMy WebLinkAboutLand Alteration O�OG City of Orono FOR C USE ONLY
P.O.Box 66 Date Received: Zj3 Permit# zJ1
2750 Kelley Parkway
''< Crystal Bay,MN 55323
(952)249-4600 Amount; $ C.U.P Filed:
Approved By: Site Plan:
Recommends: Approval ❑ Denial
CITY OF ORONO-USER DEFINED/GENERAL PERMIT T 6 C-AA 50
(All permits must be approved by the Building Official and/or Zoning Department)
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Site Address: _ 3 5;0 5' 14,)0&
Owner: J 'PUS G N-�L Mailing Address: 5s7m
City: n>7 Zip: �� 3
Home Phone: 6 1 Alternate Phone:
Contractor/App.: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
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❑ Stairway to Lake ❑ Retaining_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 G
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.
'Appli t Date
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