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,�0� City of Orono �rV( o�Z�-��� FOR CITY USE ONLY , <br /> O{ O P•O.Box 66 Date Received: [Y„_ ��, Permit# <br /> �� 2750 Kelley Parkway <br /> a 't�{�r%r. � C stal Ba ,MN 55323 � � � <br /> �, �.� ti rY Y Amount: $ (; d .U.P Filed: <br /> ��,����y�` (952)249-4600 � �v � . <br /> �KOs Approved By Site Plan: U '2'2 b <br /> Recommends: A roval Denial ❑ <br /> �3sia3 <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved Uy the Building Official and/or Zoning Department) <br /> 'Job Site/Owner Inforniation: <br /> Site Address: . � � �C' � ��v •'� �,��V�� d r ��t/ e <br /> Owner: ��C l��t✓`c�` IJ (`v� ►� Mailing Address: <br /> City: �►��' �� �' Zip: <br /> Home Phone: Alternate Phone: <br /> Conhactor/Applicant Information: � <br /> p�S i''��. I <br /> Contractor/App.:-S U��'r't� �" ��'s�� �'� �'`�"`�'S��Contact Person: ��f k v1 (U� IS� ✓1 <br /> Address: �� O �j�J�( 3 � c� State License#: <br /> City: �'�'� rf�' Zip: �S 3� � Expiration Date: <br /> Phone: 76 3 `� 7� '�� �� � Alternate Phone: 6�� `? C�' � o (��/ <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake [�'Retainin Walls ❑ Temporarv Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> *(Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ D G�', v� <br /> ❑ Docks—42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00(Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate; that the wark will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code;that I understand this is not a permit and work is not to start without a perniit;and that the work <br /> will be in acco ce with the approved plan. <br /> ----- ����� ��- t 5=� s <br /> plicant Date <br /> (Usc DeSned Permit 3/18/Qy) <br />