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�¢�� City of Orono FOR CITY USE ONLY <br /> ��� P.O.Box 66 Date Received -i ' Permit# <br /> � �, 2750 Keliey Parkway ��" ���`�� <br /> \� 1}�t��,' ��� Crystal Bay,MN 55323 - � <br /> ���\'�.F�r�v'$`y�� (952)249-4600 Amou�t: $ C.U.P Filed: <br /> \=�� <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: ��� � �c�d�'_�S / �����2�S ����/iv� <br /> Owner: ,�'1�, 'C�Z ! ����Zr,/iV; /� Mailing Address: ���%� �c���-c'S � /���S l�.v <br /> � <br /> City: Q�10��� Zip: �S� ��4 <br /> Home Phone: �7�2 ;� �' ,� j 6Z� Alternate Phone: ��Z � `?.S ��Z�' <br /> Contractor/Applicant Information: <br /> Contractor/App.: C�nr,tact PPr�nn• <br /> Address: /'E���►i� �c".�:�,���;�r' <br /> ' l�An ��� T v/�� 5—va �/3.c_ <br /> city: �nj���. f �.� RvS. o�- ��! <br /> - /w�[.�iNin,g L.i A//3 ��SGo v M-c�e.� ��.1 <br /> CA ✓ <br /> Phone: "�° �G4r� �� ��c.�.sit�.u�-�J.r,o�.�,�c�5 <br /> - (,Jv�IL/� ��v i�th�'J C c,� � / <br /> - inro�u,,/ /l.��u,.t.F Gven�r�D ,�cr.tie�i'?v'-.' <br /> -ro a�r-e�tn.,�„�2 £��,�s�i�.. T p,�,.c_' <br /> - G r rt�5 �o�, �-v �n.4+.Q ,O/�4:'i���F,-1 ' <br /> ❑ Stairway to Lake � �-� � ❑ Temporary Trailer <br /> General-User Defined Surchar ��wW''�9 'n S �TLr <br /> g General-User Defined <br /> * (Per UBC) � � *$30.00 <br /> *Estimated Cost: $ � '�` ar-�P � P � <br /> /�..�� (rv �r�. ,q�/3�i�� o s.i 2 2 j-o(v <br /> ❑ Docks-42"or Greater ❑ Zoning Review <br /> General-User Defined Surcharg General-User Defined <br /> ❑ Commercial-(Per UE *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-UserDefined ❑ SO1+CubICYards <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 wor will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code; th understand this is not a permit and work is not to start without a permit; and that the <br /> work will be in ordance with the approved plan. <br /> ' ' l;, , <br /> „ , <br /> , <br /> -� �%� �;��l�__.--- z�J 7 Cj� <br /> Applicant Date <br /> Reset Form �U9��0a�e�t3�18��; <br />