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. . � �/" ,f� _ _ <br /> �-a� <br /> ,��� City of Orono FOR CITY U5E O�ILY <br /> � 0 P•0.Bo�66 Dzte Received: ' L cY" Permit# " �/C�C' , <br /> �i;�•,;.,,. � 27�0 Kelley Parl.way O0 <br /> � �1'�?P��4r• �' Cr s[al B2 MN 55_2. <br /> �t 1�1..{<<,,,; F Y Y� Amount: S SO C.U.P Filed: <br /> �'�'�e���o�o/ (952)2a9-�1G00 � <br /> Approved By: Site Plan:� 'Z •O <br /> Recommends: A roval Denial ❑ <br /> CIT1' OF ORONO - USER DEFI�'ED/GENERA.L PERIVIIT <br /> (All pe»»i[5 mus[be�pproved by thz Buildi�lg Official and!or Zoning Department) <br /> Job Site/O�«ier I�ifornlation: <br /> Site Address: �� � � ��,�� � �� - <br /> � <br /> O�vner: � ��2�a�f-�� Mailing Address: � <br /> City: ���(� �� � Zip: � <br /> Home Phone:��� ��� ��� A1tenlate Phone: <br /> Conh-actor/ Applicant I�ifomlation: <br /> Contractor/App.:/�t�(�(:,� ���Ci (��`i Contact Person: � <br /> / r � <br /> Address: �/G�� �"���� �- State License �: � � <br /> City:�,� �U�S �C� Zip: �-� E�piration Date: � -�/ �� <br /> 5��2 c�� �� � , <br /> Phone: � � Altei�zatePhone: �i2'G��-U��-� <br /> 'I"4'PES OF USER DEFINED PERIVI�TS <br /> ❑ Stairway to Lal:e ❑ RetaininQ Walls ❑ Temporarv Trailer <br /> General—User Defined Swcharge General—User Defined Surcharoe General—User Defined <br /> * (Per UBC) * (Per UBC) x $30.00 <br /> *Estimated Cost: � * stimated Cost: S <br /> ❑ Docks-4�" or Gre�ter Land Alteration ❑ Zonina Review <br /> Gene:al—User Detined Surchar�e Gzner I—Us�r De;ined Generai—User Defined <br /> ❑ Connnercial-(Pe� U�C) �00-�OOCubicYards *ForO-%�'Zone-530.00 <br /> " Estimated Cost: � SSQ.00 (�eeds Si�e Pian) <br /> General-User Delined ❑ 501+Cubic Yards <br /> � Fesidential- �30.00 ��0.00 ��eeds C.U.P.) <br /> � Tree Remova� <br /> General—User Defined <br /> *Within 0-75' - ��0.00 <br /> I her�y apply for a Lser Defined Pezznit and I ackno�yX;�zat the information abo�-e is complete and <br /> accurate; that the work�vi�l be in confornzance with t' rdinances anc't Codes of e Citv and with the State <br /> Buildine Code;tnat I under�tand this is not a perm;�F ��ork is � o start wit pu�ap;r;nit;and thai the work <br /> wii1.be in acco-dance witn the approved plan. ///� � ' <br /> ,.. <br /> I` <br />