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HomeMy WebLinkAbout2005-P09304 - land alteration � PERMIT CI�Y OF ORONO 2750 Kelley Parkway- PO Box 66 Permit Number: Po9304 Crystal Bay, Minnesota 55323 Permit Type: User Defined . (952) 249-4600 Date Issued: 10/14/2005 SITE ADDRESS: 4760 North Arm Dr W Unit# Mound,MN 55364 PID: 06-117-23-23-0010 DESCRIPTION: Proposed Use: Residential Pernut Class: General Permit Type: User Defined Permit Sub-type(s): Land Alterarion(0-500 cu yc DETAILS: Approved per resolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 50.00 Valuation: $ 0.00 TOTAL FEE: $ 50.00 APPLICANT: Owner/Self OWNER: Patrick&Cindy Fleming MN 4760 North Arm Drive Mound,MN 55364 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF ESOTA BUILDING CODE REQUIREMENTS. , , ,.. � i -` � � � �.J���.t v`��c/1 /� APPLICANT PERMITEE GNATURE ISSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 � ���� City of Orono FOR CITY USE ONLY '� P.O.Boa 66 Date Received: Permit# ��;;,_,,.,. � � 2750 Kelley Parkway ,� �y`�r�- �'�,� CrysYal Bay,MN 55323 �� u:�"�4`�`% (952)249-4600 Amount: $ C:U.P Filed: ��o/ Approved By:�i'����te Plan:/�'� Recommends: A roval Denial ❑ CITY OF ORONO - USER DEFINED/GENERAL PERMIT � (All permits must be approved by the Building Official and/or Zoning DepaRment) ��Job Site l Owner Information: Site Address: ` � ( la C.� ��l �^ ��-'r� t� ,2_� � iZ__ _ Owner: �-�� � F 1�.v�n i ��•.� r Mailin Address: -7 g �'� /�iu fvcizf/1. r4n�u Y)•Z. . c�ty: � �2-° "' Q , zip: _�"��� �y Home Phone: 1 S z``� � Z' � � �1 S Z . Alternate Phone: i��2-'��-I I-y y I C�. Contractor/Applicant Information: Contractor/App.: Contact Person: Address: State License #: City: Zip: Expiration Date: Phone: Alternate Phone: TYPES OF USER DEFINED PERMITS ❑ 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 ❑ Zonin�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.��(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 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 (�vor�will be in accardance with the approved plan. !� -�': �~ ' ��,t J , �---i----` ��.? -�U '� j - � Applicant �,... � � � Date Res�t Form ��� ;:. ��9��;�,���:����i �._ .�� , �..-._— - ___ __ _ . ... . .,_ , q._'_. � _._. ` . �. ...... . .. . � ..._. y _ ..... .� .. . .. . 4 � _ , ,� `� ��.� � � ; ,. 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