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4 p� City of Orono <br /> 4L �r\\ FOR CITY USE ONLY <br /> P.O.Box 66 <br /> Q Q�\ Date Received �' 7permit# `-+-��C <br /> � 2750 Kelley Parl.tivay �, y <br /> ��x 1��L�l�" '' C ry s[a l B a y,M I�`5 5 32 3 <br /> ���vt'�i�yo�� (952)249-4600 Amount: $ �° C.U.P Filed: ' <br /> �—�'� Approved By: � Site Plan: <br /> L <br /> Z�������� , � ` <br /> K� ` <br /> (_ Recommends: A roval Denial ❑ <br /> �� W� rl•� i2 Lv,5� o,�.f� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pennits must be zpproved by the Building Official and/or Zoning Department) <br /> Job Site /Owner Information: <br /> Site Address: � � 7� �j/7'J �/!/!7 O �-/ /`! l�� . <br /> Ow�ner: �d �d/''/0 C l� Mailing Address: �oun d <br /> c�ty: ��a►�c� z�p: 5536� <br /> Home Phone: 7`7� 37/ � Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEEINED PERMITS <br /> ❑ Stairwav to Lake ❑ Retainina Walls ❑ Temporarv Trailer <br /> General–User Defined Surcharge General–User Deined Surcharge General–User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: � * Estimated Cost: $ <br /> ❑ Docks—42" or Greater �Land Alteration ❑ ZoninQ Review <br /> General–User Defined Surcharge Ge ral–User Defined General–User Defined <br /> ❑ Conmlercial—(Per UBC) �0-500 Cubic Yards *ForO-7S'Zone-�30.00 <br /> * Estimated Cost: � �50.00(Needs Site Planj <br /> General–User Defined ❑ 501 T CubtC YardS <br /> ❑ Residential - 530.00 �50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General–User Def ned <br /> * �'��ithin 0-7�' -�30.00 <br /> I herby apply for a User Defined Permit and I ac}:no�i�ledQe that the information above is complete and <br /> accurat�;that the work will be in confarmance�vith the Ordinances and Codes of the City and with the State <br /> Building Code; that I understand this is not a permii and ��-ork is n�t to start ��,�ithout a permit; and that the <br /> ���ork���ill be in accordance ��ith the appro`�ed plan. <br /> � - -„��.����.,� �� C" �o o �- <br /> Applicant Date <br /> Reset Form c�5�,D_�:,_«_�,,:,;�a,�.� <br />