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�vn�ng rermli A IICa'[lOt1 <br /> . MailingAddress: Permit number: ' b - �O(o Z � <br /> �Q�O PO Box 66 <br /> Crystal Bay,MN 55323-0066 Date received: .�..`�"��� 2� 1� <br /> ��oyie I e F+ Escrow#and <br /> Streef Address: 5�2.c J i S amount: <br /> �, � 2750 Kelley Parkway <br /> y�, ; Orono, MN 55356 Permit Fee: <br /> G <br /> lqkf S H O�� Fax: 952-249-4616 APProved by: <br /> Main: 952-249-4600 Notes: <br /> www.ci.orono.mn.us . <br /> This application form must be completed in full and all required information must be submitted. (P/ease print.) <br /> Job Site Address: '�j L 1ilC� Lt t�1� ��� r( 1 ��9l� -�j�j� -�jq <br /> CONTRACTOR FORMATION: <br /> Name: � � LI�C�C.11�(,(.,h <br /> Phone: �j- - ^ F�: <br /> Address: II_ �..UC� t�1r � � Ci : �r'l ._ ZIP: 5;' �-c <br /> Contact Person: ,��� � �� - ��� ContacYs phone number �'�� -�3�-�(� <br /> Email 5 i^[�������,.C�M 'V1 ['t�MAPPlicant is: Contractor omeown (Circle One) <br /> � <br /> -•�_� <br /> PROPERTY OWNER INFORMATION: <br /> Name: ��i �c L �-C�(�'����� <br /> Phone (day): �' � ^ ��, <br /> Mailing Address: � L.U c C u�' � 't G�G V�l n-� ZI P: �;S �'�• <br /> Email and/or Fax �� - � �,,s��, � �,,�,� - <br /> Overall Project Description: � .�f � ' ��'(h L�.o'�C(� tr <i St�� -� �,`, � �r'���� (c� � Il:i� <br /> c'C:Se���F���_ }��i t I� ���,l(�i..Y ' �i CGti'C�Y2;.�.�1 -�-4t1( �(`• <br /> Check <br /> Box TYPE OF PERMIT COST* <br /> Dock, Commercial $50+engineering review costs <br /> Escrow for erosion control and en ineerin review costs $2,000 <br /> Dock, Residential-Permanent dock on any lake or initial seasonal dock not $50 +engineering review costs <br /> on Lake Minnetonka ermanent dock re uires CUP <br /> � Hardcover Permit: Driveway, Patio, Sidewalk, etc. (New or Replacement) No charge <br /> Also requires is a Minor or Major <br /> Land Alteration Permit <br /> Land Altera �n, Maior(aradina. fillinn �r Ay�a"�+�n..� more 500 cubic yards $50 <br /> or mor requires CUP) <br /> Escro� � Q , �(O I� � S As determined b CUP <br /> Land/ �y`� � -500 or less cubic $50+engineering review costs <br /> ;,� yards c s in lakeshore setback <br /> Escro� � Q � ts $2,000 <br /> Retain W l � � ing permit. $50+engineering review costs <br /> Retaini tom of footings to top <br /> of wall) �are considered one <br /> wall un � ►f the lower wall.) <br /> Escrov � $2,500 <br /> Stairw� $50+engineering review costs <br /> Escrov C' � ��,-,'D ' $2,000 <br /> Struct� `.�� ilding permit but $50+en ineerin review <br /> regulatE �accessory building 9 g �sts <br /> of less 3nd sport court) <br /> EscroH c $2,500 <br /> Tree R� 'oot zone No Cha� e. Pre-ins ection re uired. <br /> Tem o h buildin ermit $30 <br /> (over) <br /> ,. _�;�.����� *Permit fee will be collected when the permit is issued. <br /> � �';��d� <br /> Updated: January 2015 <br /> ,,;:.:i: <br /> �;��J <br /> Ci i... , .. ,_ �:ZvtV�J <br />