HomeMy WebLinkAbout2003-p06694 - land alteration ITY F R N PERMIT
C O O O O
2750 Kelle� Parkway - PO Box 66 Permit Number: Po6694
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) L49-4600 Date Issued: 9isi2oo3
SITE ADDRESS: 4245 Chippewa Lane
Maple Plain,MN 55359
PI D: 31-118-23-42-0001
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: User Defined Permit Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Separate pernuts required:
NOTICES/REMARKS:
For seeding back yard-Approx 50-60 yards of black dirt
FEE SUMMARY: PernutFee: $ 50.00 Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/Self OWNER: 7on Adams&Clea Altman
1V1N 4245 Chippewa Lane
Maple Plain,MN 55359
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEIvIENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
, � � C
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Apolicant, 1-Monthlv Reports, 1-Assessine, 1-Finance Page 1
p City of Orono
'Q�' � FOR C Y USE ONLY
P.O.Box 66 �� �,� �(`�
� � Date Received: Permit# - � '
� 2750 Kelley Parkway �� �� �:3
'� ��'� ,� � Crystal Bay,MN 55323 '�
Amount: $ ��� C.U.P Filed:
�� R' y� (952)249�600
y,sso$
. Approved By: Site Plan:
Recommends: A rov Denial ❑
CITY OF ORONO - USER DEFINED/GENERAL PERMIT
(All permits must be approved by the Building Official and/or Zoning Departrnent)
Job�Site t Owner Information: ��� � � '�ti" `���:�'
�
Site Address: � � l-� ,�,J ,
Owner: ��/ � ,,.) Gt •�t
� � S Mailing Address: �S e� ..... t
City: . �/'o•J v Zip: S��,S�'
Home Phone: �,�� "-��3' `���j Alternate Phone: �p/�" ��y �f Zf/L
�Con�ra�tor/Applicant Information: ��� � `
� ,� ,. � ��.;
Contractor/App.: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
TYPES OF USER DEFINED PERII7ITS ' '
x 7y,g,3':.t+ �
�
❑ Stairwav to Lake ❑ Retainin Walls ❑ Temporary Trailer
General—User Defined Surcharge General—User Defined Surcharge Generai—User Defined
*(Per UBC) * (Per L'B�) * �30.00
*Estimated Cost: $ *Estimated Cost: $
❑ Docks-42"or Greater �Land Alteration ❑ Zoning Review
General—User Defined Surcharge General—User Defined General—User Defined
❑ Commercia l-(Per UBC) 0-500' -$50.00(tveeds sice Pian) *For 0-75'Zone-$30.00
*Estimated Cost: $ �501' +_$�S.00(Needs C.U.P.)
General—User Defined
❑ Residential- $30.00 /�-�
�v r ,S'r r,�% ^- �a �/�' q �
❑ Tree Removal � �
Genera(—User Defined � , ���`�
*Wittun 0-75' -$30.00 ���o�, -�—� ^�O��
j/'�' .
I herby apply for a User Defined Permit and I acknowledge that the information above is complete �nd
accurate; that the wark will be in conformance with the Ordinances and Codes of the City and with the Sta.t�
Building Code;that I understand this is not a pernut and work is not to start without a pernut;and that the work
will be in accordan roved plan.
_ e� v�- ����
Applica Date
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or Section 31, Township 1 1 F
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(95}0�.3) over the north 1 rad of the
TE T HOI.E / 1 �t�� o� ����o ��.�arter.
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'� SITG PLAN � GC DING PLAA1 '
� APPF�OWcu A- � t
Cl ��'��'0�'CL� b1r{T'� REV15fONS
. CJ DI�N�'F'�OV�
BY �''
DATE.___.-�- Y- �3 . Tf�is survey shows the baoun
, . - < ' location of a proposed buildir
f� encroachments, other than a�
� oouth lir e of E 1
NW 1/4 SE 1/4, Sec. 31-118–�23 ��
i R�19j�08
:... „ • C,280 5' 42" i�,�
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• � `� � � . Iran marker
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�.�,�, � � � L�� : Proposed spo t elevc
D��tum: Mean sea level
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B�arings shown are based uF
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