HomeMy WebLinkAbout2007-P11735 - land alteration PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: P11735
Crystal Bay, Minnesota 55323 Permit Type: User Defined
(952) 249-4600 Date Issued: 12/10/2007
SITE ADDRESS: 585 Old Crystal Bay Rd S Unit#
Long Lake,MN 55356
PID: 04-117-23-31-0006
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 permits required:
NOTICES/REMARKS:
Ok'd By:Bruce V&Per Tom Kellogg&MCWD
FEE SUMMARY: Permit Fee: $ 50.00
Valuation: $ 0.00
TOTAL FEE: $ 50.00
APPLICANT: Roto Rooter Services Co. OWNER: Mr&Mrs Paul Berggren
14530 27th Ave.N. 585 Old Crystal Bay Rd S
Minneapolis,MN 55447 Long Lake MN 55356
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
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PE' E SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
,g,off\ City of Orono FOR CITY USE ONLY
P.O.Box 66
�, Q Date Received: Permit#
4A,.,, 2750 Kelley Parkway
' i i,�'�s!?- ,. Crystal Bay,MN 55323
e o o (952)249-4600 Amount: $ CU.?Filed:
Approved By: Site Plan:
Recommends: Approval ❑ Denial ❑
CITY OF ORONO -USER DEFINED/GENERAL PERMIT
(All permits must be approved by the Building Official and/or Zoning Department)
Job Site./Owner Information:
Site Address: 5-55- 3--- --X:7' .--.7,`" ...C.,*(.' //3:17- ,c/
Owner: f v/,eeryy,-may, Mailing Address: 5-,5-57 0,Cci5/S /,,?..7�
City: I'D/70 Zip: S-5-3'S- e
Home Phone: Alternate Phone:
Contractor/Applicant Information
Contractor/App.: 57.14 'vic--v--- Contact Person: .//egie/i-e"
Address: /0 Z 7. 49vI A.) State License #: D Z69 95- 54
City: 4/yIDU Zip: c$'V7 Expiration Date:
Phone: 73/?-,y Z yAlternate Phone: 7I'3-2 S'c -fZ 7/
7/ ? Z8(i, 8323
!I:4, 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:$
E Docks-42"or Greater Z Land Alteration ❑ Zoning Review
General-User Defined Surcharge General-User Defined General-User Defined
❑ Commercial-(Per UBC) rA 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 �Ur� e O(N
General-User Defined l
* Within 0-75' -$30.00 c2 (Ott - ) l D
l
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 b ' ordan- with the approved plan.
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pplicant Date
Reset Form (User DefvdPermit 3/15/04)
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