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• ,��,�` City of Orono FOR CITY USE ONLY �Y,, <br /> "r P.O.Box 66 <br /> Date Received: Permit# !�►U� � <br /> � , ��°,ti,,� � 2750 Kelley Parkway �V� <br /> � dl�'�ti�� � C stal Ba MN 55323 � L� <br /> a ,� `"- F rY Y> �^' Amount: ' $ ��� C.U.P Filed: _['i� <br /> �����ti�` (9sz>249-a600 � • n_ <br /> $ �� �� ,ati�q ( � <br /> � � ��� �� Approved By: �G� Site Plan: �'�" <br /> Recommends: A roval [� Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Inforniation: <br /> Site Address: L- � ���% ��-�'���`���t.�,. ��°�� � <br /> Owner: _� �Y 1 <� LYi.;iC�'1`=>c-�ti'1 Mailing Address: L��L C �•�-����-, Sic� <br /> City: Zip: 5`> �> � <br /> Home Phone: �I'r�L -``�7� " � ���-"�' Alternate Phone: ����'k � ���; '�� 1�"���S�r�„tv,� <br /> . , <br /> Conhactor/Applicant Informatioii: <br /> Contractor/App.: ������►rYl Z Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> ` �XPES QF II�ER DEFINED°PERMITS <br /> ❑ Stairway to Lake ❑ Retainin� Walls ❑ Tempararv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $ <br /> ❑ Docks-One Time(tvo„-r,ake Mtka) ���Land Alteration .y�,,,,=.,X,�-1- ❑ Zonin�Review <br /> General—User Defined Surcharge General—User Defined ��e:�•.,✓� General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *ESt1ri18fCd COSt: $ �5�.0� (Needs Site Plan) <br /> General—User Defined ❑ 501+CublC Y1[ds <br /> ❑ Residential- $30.00 $50.00 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> Genera]—User Defined <br /> * Within 0-75' -$30.00 <br /> I herUy apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate; that the work will 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 work is not to start without a permit;and that the wark <br /> will be in accordance with the approved plan. <br /> Applicant Date <br /> (User DefinedPemtit 05/08/09) <br />