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�0� City of Orono FO�USE ONLY <br /> O Q P•O.Box G6 Date Received• O O Permit# �� �� <br /> ����,� 2750 Kelley Parktivay � � � � � <br /> � � �il�'���. � C stal Ba ,MN 55323 �G <br /> �, rY Y Amount: $�_ C.U.P Filed: <br /> r . �'���J��$�` (952)249-4600 ^ <br /> �exO Approved By:p�`� • Site Plan: <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pemiits musc Ue approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner I�ifornlation: <br /> Site Address: ��� �� ��;r''81'�1 U ��ti� <br /> Owner: �n�'�'����7 � •'7�-��� Mailing Address: 5�'� <br /> City: L.�!J V �� Zip: �� � 1�.- `� ���-V� � <br /> �{� S <br /> Home Phone: � � ��'� �� � `�" Alternate Phone: �a �2� Z`t Z- 8� � <br /> Contractor/Applicant Inforniation: <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ' TYPES OF USER DEFINED PEI2MITS : <br /> �Stairway to Lake ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User Defined Surcharge Generai—User Defined Surcharge General—User Defined <br /> * (Per UBC) , * (Per UBC) * $30.00 <br /> *Estimated Cost: $� �r�t� *Estimated Cost: $ <br /> ❑ Docks-42" or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—liser Defined General—User Defined <br /> ❑ Corrunercial-(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 $SO.00 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> * Witliin 0-75' -$30.00 <br /> I herby apply for a User Defined Pen-nit and I acl:nowledge that the information above is complete and <br /> accurate; that the work will Ue in conformance with the Ordinances and Codes of the City and with the State <br /> Bui �ing Code;that I understand this is not a pemzit and work is not to start without a pernut;and that the work <br /> w 1 e in ac r n with the approved plan. <br /> ,�� �v(��_ � �i ir `�`"� <br /> r <br /> Applicant Date <br /> (IJser Defined➢crmit 3/18lOa1 <br />