HomeMy WebLinkAbout2004-P07998 - land alteration f �.
ITY F R N PERMIT
C � � � � Permit Number:
2750 Kelley Parkway- PO Box 66 P07998
Crystal Bay, Minnesota 55323 � Permit Type: user Def�ea
(952) 249-4600 Date Issued: 9i2s�2ooa
SITE ADDRESS: 185 Old Crystal Bay Rd N
LONG LAKE,MN 55356
P I D: 33-118-23-34-0001
DESCRI PTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: User Defined Pernut Sub-type(s): Land Alteration(0-500 cu yc
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 50.00 Valuation• $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Owner/Self OWNER: L S STUBBS ETAL
MN 185 OLD CRYSTAL BAY RD N
LONG LAKE MN 55356
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN SI'RICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCFS AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE I SUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Annlicant, 1-Monthlv Renorts, 1-Assessine, 1-Finance Page 1
� .
O���O City of Orono FOR CITY USE ONLY
P.O.Box 66 Date Received: PeRnit#
q�,�, 2750 Kelley Parkway
a 4j!����:`;- � Crystal Bay,MN 55323 Amounr. . $ C.U.P Filed:
�A���o�o� 952 �49-4600
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Approved By: Site Plan:
Recommends: A roval ❑ Denial ❑
CITY OF ORONO - USER DEFINED/GENERAL PERMIT
(All pemiiu must be approved Uy the Building Official and/or Zoning Department)
JoU Site/Owner Infornlation:
Site Address: � � '� � �1�utcf; ��-} /�� '��._
Owner: �/� .�`�-� Mailing Address: '
City: ��a�' Zip:
Home Phone: � S�� '�7�- ���7 Alteizzate Phone:
Contractor/Applicant Information:
Contractor/App.: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Plione:
TYPES OF USER DEFINED PERMITS
❑ Stairwav to Lake ❑ RetaininQ Walls ❑ Temporarv 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 e Land Alteration ❑ Zoning Review
General-User Defined Surcharge General-User Defined General-User Defined
❑ Commercial-(Per UBC) [.� 0-500 Cubic Yards *ForO-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 aclmowledge 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 pernut and work is not to start without a pernut;and that the work
will be in accordance with the approved plan.
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