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" ,��� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received: Perrnit# <br /> O�:ea.,, O 27�0 Keliey Park��ay <br /> � il''J:�:�'. � Cr stal B2 MN 55=2= <br /> �, �.�,�i.,,,. � y y, Antoun[: $ C.U.P Filed: <br /> �'���e����c/ �95����i9-=1GG0 <br /> Approved By: �e� Site Plan: �L 2'a� <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFTNED/GENERAL PERIVIIT <br /> (All pznnits must be approved by thz Building Official and%or Zonine Department) <br /> Job Site/O�«ier I�iforniation: <br /> � � <br /> Site Address: ' �� - <br /> Owner: ��6�'�( Mailin� Address: <br /> City: �r�v � Zip: <br /> Home.Phone: {=-�/Z ���,� ��C(��> Alteniate Phone: <br /> Conh-actor/ Applicant I�ifomiation: <br /> Contractor/App.: ��'� COI1t3Ct PZl'S011: <br /> Address: State License �: <br /> City: Zip: Expiration Date: <br /> Phone: Altei,zate Phone: <br /> TYPES OF USER DEFINED PERNIYTS <br /> ❑ Stair���ay to Lalce ❑ Retai�7inQ Walls ❑ Teinporary Trailer <br /> General—User Defined Surchar�e General—User Defined Surcharoe General—Uszr Defined <br /> * (Per UI3C) * (Per UBC) * $30.00 <br /> "Estimated Cost: � *Estimated Cost: S <br /> ❑ Docks—4?" or Gre�ter .� Land Alteration ❑ ZoninQ Review <br /> General—L's�r Deiined Surciiar�e Gzneral—Us.r Detined General—User Delined <br /> ❑ Conunercial—(Per UEC) � 0-�00 Cubic Yards *ForO-75'Zone-�30.00 <br /> * Estimated Cost: � 550.00(ueeds S�e: Pian) <br /> General-User Deti,,ed ❑ 501+Cubic Yards <br /> ❑ Residential- �30.00 ��0.00 (Needs C.U.[�.) <br /> ❑ Tree Remova? �XC�✓�+7 0"� �°� F�-r�wV 6�-*�� <br /> General—User Defined �, � �!�}-e,l �„�' 4�i'�� t� ►= � (7`,�� <br /> * W ifnin 0-i5' - �30.00 <br /> I herby apply for a liser Defined Penr.it and I ackz:o�vledQe that the iniormation abo��e is comp:ete and <br /> accurate; tnat the work ti��iil be in conforniance with the Ordinances ana Codes of the City and tivith the State <br /> Bt::ldina Code;fna'I uncerstand this is not a peiznit and work is not to star�witnout a permit;and that the«�ork <br /> wiil be in acco-dar.ce w�tn the approved plan. <br />