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�,¢�� City of Orono FOR CITY USE ONLY ��I <br /> � P.O.Box 66 / <br /> 0, 0 , Date Received: Pemtit# ' /�� <br /> � y� . 2750 Keiley Paricway ; �.�� 'Cv <br /> � ��I���f.;i �� Crystal Bay,Ml�'S53'_'3 j �� � � � � <br /> � � ���ti���M�.�o i�, (952)249-4600 r , !��'` ��. Ainount: $ C.U.P Filed: <br /> ,� � CI <br /> , n <br /> '�� APProved By: _ Site Plan: /J j� V' � <br /> � R' G <br /> Recommendx A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pennits must be approved by the Buil ding Official and/or Zoning Department) <br /> ;Job Site/Owner Infonnation:. <br /> Site Address: _� �� �/ L_:_�/�7`— ��/L `� � <br /> , <br /> Owner: ���- �' L�����!"f ���'�°l�-� MailingAddress: ��1�—/ ��c-�� <br /> City: ��,��i"7" � Zip: <br /> Home Phone: Alternate Phone: <br /> >Contractor/.:Applicant Inforrnation � <br /> Contractor/App.:� i, � �f%/�/�> l�c�'C'i"C�' Contact Person: /'��ic'lfi�-L�L /��5 <br /> Address; �,� ����� �` > i'1', State License #: Z-� �- 3� `�C� l�. <br /> ���� -�; <br /> City: � � Zip: %��� $xpiration Date: �� � � " �� % <br /> � � <br /> Phone: /;i,Z. � �� ��7' �">� `% Alternate Phone: <br /> �::��a �-k.�:"u • �; .r . ;TYPES OF:U.SER DEFINED PERIVIITS -. � :;� ,., - - `�,t �, ;; <br /> ❑ Stairwav to Lake ❑ Retainine Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Def ned Surcharge General—User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: $ *Estimated Cost: $ <br /> ❑ Docks-42"or Greater (�Land Alteration ❑ Zonin�Review <br /> General—User Defined S urcharge � Generai—User Defined <br /> General—User Defined <br /> ❑ Commercial-(Per UBC) 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ �50.00(Needs Site Pian) <br /> General-User De2med ❑ 501� Cubie Z'ards <br /> ❑ Residential- �30.00 �50.00(Needs C.U.P.) <br /> ❑ Tree Removal �� i� �� �_.-�i�=' ��� H--/%�,� � �L�� �r �i�L <br /> General—User Defined <br /> * Within 0-75' -�30.00 <br /> I herby apply for a User Derined Permit and I acl:nowledge that the infonnation above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and�vith the State <br /> Building Code; that I understand this is not a permit and work is not to start without a pennit; and that the <br /> ���ork ���ill be in ccqJdance wi the a proved plan. <br /> / �' �'k ,/4� � �_c-l l`j <br /> �� <br /> Ap licant _. Date <br /> Reset Form (UserDcSnndYcrmi!;;�a;�l� <br />