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� _ <br /> ¢�� City of Orono � , ROR CITY USE ONLY <br /> 0 , 0��\ P.O.Boz 66 Date Received: ��-(� Permit# ���/1� <br /> s� � 2750 Kelley Par(.�vay ti�T <br /> ,� ��1 y,�;'-- ''� Crys[al Bay,MI�'S5323 G,t�� <br /> ��' ��1� �v y�� (952)249-4600 Amount: $�v•�D C.U.P Filed: <br /> �sa"°�` �y�,� <br /> Approved By: u'l�" Site Plan: <br /> �%K�/� <br /> _ ./ <br /> Recommends: A roval 0' Denial ❑ <br /> CITY OF ORONO -USER DEFINED/GENERAL PERMIT <br /> (All pennits must be approved by the Building Officizl and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Site Address: •�`` �`� � �� � f� <br /> Owner: � �� �. ��ya��ilin� Address; <br /> City: ��0/I.CJ � /V zip: <br /> Home Phone: ��2 ' �U7� �D�� Alternate Phone: <br /> Contractor/Applicant Inforriiation`. <br /> /� / <br /> Contractor/App.:x� J /�ontact Person: '� .� <br /> r =/�-t1 l � l ! <br /> Address: `�G�J�O � �! /L�State/License #: �D"�����g ��!�. <br /> i <br /> City: � ,��G`Zip: �_��a�� Expiration Date: � <br /> Phone: ��a'�9`7`����� Alternate Phone: <br /> TYPES OF USER DEFINED PERNIITS : <br /> ❑ Stairwav to Lake ❑ Retainin� Walls ❑ Temporary Trailer <br /> General—User Defined 5urcharge General—User DeFned Surchar�e General—User Defined <br /> * (Per UBC) * (Per UBC) *�30.OQ <br /> *Estimated Cost: $ *Estimated Cost: � <br /> ❑ Docks-42" or Greater � Land Alteration ❑ ZoninQ 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: $ 550.00(Needs Site Plan) <br /> General—Use,Defined ❑ SOlT CubtC Yards <br /> ❑ Residential - �30.00 �_50.00(Needs C.U.P.) <br /> ❑ Tree Removal c���'/-�1 I��C,� � b�1Su�z��- (�.; �v�Cl cx; c.�.a�� �- `��c� d o�✓ <br /> G:neral—User Defned <br /> ' 1'��ithin 0-75' -�30.00 <br /> I herby apply for a User Defined Pe.rmit and I acl:no���ledge that the infonnation above is completz and <br /> accurate:that the���ork�vill be in conformance�vith the Ordinanczs and Codes of the City and�vith the State <br /> B � dina Code; t at I u derstand this is not a permit and ��rork is n�t to stan ���ithout a pennit; and that the <br /> � o � �vill in ccor ce ��' the appro��ed plan. <br /> i G� �- <br /> -// �� <br /> A plicant _ __ Date <br /> Reset Form c�S.,DeEm:dFcmi;3l18iU41 <br />