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,¢�� City of Orono FOR CITY USE ONLY <br /> 0 0�� P.O.Boz 66 Date Received: Permit# <br /> �� 2750 Kelley Parf.��ay <br /> ,�, �}1��,�'-• '` Crystal Bay,MI�'SS323 <br /> ���� (952)249-4600 Amount: $ C.U.P Fifed: <br /> Approved By: � Site Plan: �2' �•d <br /> (� <br /> Recommends: A rova Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All pennits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Tiiforination: <br /> �; '\ /� <br /> Site Address: j'�/C����� Il ) (���/��� r\ `� �`� /�� <br /> Owner: Mailing Address: <br /> City: U {���1/(7 Zip: � 5��� l � <br /> Home Phone: Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: �-�L,�(�ul� -f-��G�-�.i?rf��-'{^'�ontact Person: ' ' � ��' ��l�5 <br /> Address: ��7G �{�✓������'C���� State License #: <br /> City: S� ��� Zip: s� -�T`� Expiration Date: <br /> /- �� � <br /> Phone: l��'� -�'� S S ��� Alternate Phone: <br /> ' TYPES OF USER DEFINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retainin�Walls ❑ Teinporary Trailer <br /> General—User Defined 5urcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) *a30.00 <br /> *Estimated Cost: � *Estimated Cost: $ <br /> ❑ Docks—42" or Greater �and Alteration ❑ ZoninQ Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per USC) �'0-500 Cubic Yards *ForO-75'Zone-�3p.00 <br /> " Estimated Cost: � SJ0.00(Needs Site Planj <br /> General—Use,-Defined ❑ 501 T-CublC Yards <br /> ❑ Residential - �30.00 �50.00 (Needs C.li.P.) <br /> ❑ Tree Re�noval <br /> General—User Def ned <br /> * «'ithin 0-7�' -�30.00 <br /> I herby apply for a User Defined Permit and I acl:no«�ledQe that the infonnation above is complete and <br /> accurate;that the work�vill 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 ��-ork is not to start ���ithout a pennir, and that the <br /> ���ork� ill be in a ordance�vith the appro��ed plan. <br /> __L � � �'/ll l G �1 <br /> applicant �. Date <br /> Reset Form c�s�,-D_�-_,_zr_�„�;�3��� <br />