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� � � � <br /> � I � �I �� '���� <br /> �I r <br /> ��� � <br /> ��� City roe�t�'p no ��I_ ,�� FOR CITY'USE ONLY <br /> P.O.Boz 66 ��� � D7 � 17p3 <br /> O O Date Receivcd. / —Z� Pe;mit# � <br /> 1 � 11 2750 I�elley Parkway ( �(^,�.� <br /> ,� �I y ur=. �� Crys:al Bay,MN 55323 ��� <br /> ��° �"'� ��`y�, (953)249-4600 <br /> e,��oa n� /' �� Amount: $ C.U.P Filed: <br /> ' i l. <br /> 11� 1`eS�byvi� T APProvedBy: SitePlan: <br /> � V C;d/N*i��I- <br /> L`�^( I�- �� I Recommends: A rova! ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PER.IVIIT <br /> (A1I penniu must be approved'oy the Building Offic;al and/or Zoning DepaRment; <br /> :7ob S:ite/ Owner Information: <br /> Site Address: (� � <br /> Owner: ���� uUG�����5�"' Mailina Address: � � �� � <br /> Cli �:��L�'� r�' <br /> y� Zlp: "�.L.—��� <br /> L <br /> Home Phone: ��� ��?j'��� Alternate Phone: <br /> Contractor/Applicant Inforrnation: � <br /> Contractor/App.: LA'�l S�l�,,� ���- Contact Person: l�e �� <br /> Address: �I�.t ����� �S State License #: ZGY7 �(o�((o l <br /> City: � Zip: J`��Zc� Expiration Date: ,�j_/3��O g <br /> Phone: �' ����'°>��1.–7. � Alternate Phone: ��� �+�'��O Z. <br /> TYPES:OF tiSER DEFINED PEI2tVIITS ''- <br /> ❑ Stairwav to Lake ❑ Retainir,a Walls ❑ Teinporar Trailer <br /> General—User Defined 5urcharee General—User Defined Surcnarge General—User Defined <br /> * (Per UBC) * (Per UBC) "530.00 <br /> *Estimated Cost: � '� Estimated Cost: $ <br /> ❑ Docl:s—42" or Greater ❑ Land Alteration ❑ ZoninQ Review <br /> Generaf—User Defined Surcharge General—liser Defined General—User Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-�00 Cubic Yards *ForO-7�'Zone-530.00 <br /> * Estimated Cost: $ ��0.00(NeedsSitePlan) <br /> General-Use;Denned 501 T CubiC Z'ards <br /> ❑ Residential - �30.00 ��0.00 (Needs C.li.P.) <br /> ❑ Tree Removal <br /> G:ne;al—Clser Defncd <br /> * Within 0-7�' -�30.00 <br /> I herby apoiy for a User Defined Permit and I acl:no�vledQe that the infonnation aoove is complete and <br /> accurate;that th�work will be in conformarce �vith the Ordinances and Codes of the Ciry ar.d with the State <br /> Buildin�Code; that� unders nd ti�is is not a permit and work is not to start �vithout a pennit; and that the <br /> ��ork ��-i1] e �n acco Cance � ith the appro`�ed pian. <br /> 1 �_ ,. � w�� <br /> Appiicant _. �� � <br /> Reset Form c�sz,�_:,=dt:�,,;�;;�a,�1� . <br />