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4 Q�;� Ci �of Orono FOR CITY U5E ONLY <br /> ` P. .Box 66 � g � � <br /> �, � DateReceived: (0 Permit# DO t <br /> y�t.�, 27 D Kelley Parkway <br /> • � ��ly;��;� � C stal Bay,MIV 553'_3 <br /> � �' "�ttl�,�v�y�. (95 )249-4600 fJ.Q <br /> O ���o� Amountt $ � �C.U.P Filed: <br /> ��� Approved By: ��v, Site Plan: <br /> �O� I <br /> Recommends: A roval Demal :❑ <br /> ITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All penniu must be approved by the Buil ding Official and/or Zoning Deparpnent) <br /> Job S�ite./Owner formation. �.: <br /> Site Address: ��fi � ��G� <br /> Owner: �f �G7 ��''�� ��r�f�C'�� Mailing Address: ���'� ���t,�i,�,X �,� <br /> City: �vl� Zip: � � � � � � � <br /> Home Phone: �� `� � ��� D� � Alternate Phone: �52��-��'-T�`� �7 <br /> >Contractor/..App ca�t Irifo.rrnation �� � - � ;; <br /> Contractor/A � <br /> PP•� � �� Contact Person: /�� �yt�t�(,�e=�y� <br /> Address; / ) /3p�c �� �lfi State License#: /� ,�(' _ <br /> City: u; zip; �`�� 3�� Expiration Date: !�l - u - <br /> Phone: 6� .Z. - � z � '- �6 �� Alternate Phone: ��SZ " ��� � �j�g� <br /> '^` ` ` ` �'TYPES QF USERDEFIN �PERIYLITS <br /> �;+. ,:' h _kp.:.si, ..1� .. - <br /> - i,'�i,d <br /> ❑ Stairwav to La e ❑ Retainin� Walls ❑ Temporarv Trailer <br /> General—User Defi d 5 urcharge General—User Defined Surchazge General—User Defined <br /> * (Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Co t: $ *Esfimated Cost: S <br /> ❑ Docks—42"or reater �Land Alteration ❑ Zonin�Review <br /> General—User Defin d S urcha�ge • en I—User Defined Gcneral—liser Defined <br /> ❑ Commercial (Per UBC) �-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cos : $ $50.00(Needs Site Plan) <br /> General—UserDefin d ❑ 501+ CubicYardS <br /> ❑ Residential - �30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Def n d <br /> * Within 0-75' - 30.00 <br /> I herby apply for a ?ser Derined Permit and I acl;nowledge that tlle infonnation above is complete and <br /> accurate;that the wo k will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code; that understand this is not z permit and work is not to start without a pennit; and that the <br /> ���ork �i�ill be in acco dance with the appro��ed plan. <br /> � �C� ����� /d � <br /> Applicant , _. .. Date <br /> � � eSEI�FO�IT�I . (UserDeFmedFcnnit;;l3iUJ1 <br /> I �I <br />