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��� City of Orono FOR CITY USE ONLY <br /> � �, �� P.O.Box 66 Date Received: Permit� <br /> �;;,;.,,�� � 27�0 Kelley Parl.�vay <br /> �'' I? Cr stal Ba Mt� 5�3_3 <br /> a �j 'xi�% '' ' ' Amount: $ C.U.P Filed: <br /> � �r I:1�;,.-� � Y Y, <br /> ``"i�`yi�+jy�,� (9�2)249-4600 � <br /> ��eH° Approved By:(�� Site Plan: <br /> Recommends: A roval �. Denial ❑ <br /> �P� 6I�f� f'�I�V�( (N 1 Z'�(`� N C'.�-.+ ��, <br /> �� A,Ov 14ri/'4 5,v/l.t�'P�-� 17/�-'i 1__T� <br /> CITY OF ORONO - USER DEFINED/GENERAL PERl��IT nGri i z, o y <br /> (All pennits must Ue approved by thz Building Ofiicial andior Zonino Department) <br /> Job Site/ Owner I��fornlation: <br /> Site Address: � ��� �/l�G, � �j,�f���,�,�1��%G, <br /> —��-� F --t- <br /> Owner: �,�J ``���`�1�� Mailing Address: � �j�� <br /> City: , � Zip: �� `�j��C� <br /> � <br /> Home Phone: �J���—y�-- Altenlate Phone: �/����7�`1`�� <br /> Contractor/ Applicant I�lformation: <br /> Contractor/App.: Contact Person: ��j� �/��������� <br /> Address: State License �: <br /> City: Zip: Expiration Date: <br /> Phone: Altei�zate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to Lake �f Retainin�Walls ❑ Temporarv Trailer <br /> General-User Defined Surchar�e General-User Defined Surdiar�e General-User Defined <br /> *(Per tiBC) * (Per UBC) * $30.00 <br /> *Estimated Cost: $ *Estimated Cost: $���� <br /> ❑ Docks—42" or Greater ❑ Land Alteration ❑ Zonin�Review <br /> General-User Deiined Surchar�e General-User Defined General-User Delined <br /> ❑ Conunercial—(Per UBC) ❑ 0-500 Cubic Yards *ForO-7S Zone-$30.00 <br /> *Estimated Cost: � �SO.00 (Needs Site Plan) <br /> Gzneral-User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General-User Defined <br /> *Within 0-75' -$30.00 <br /> I herUy apply for a User Defined Permit and I aclmowledge 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 understan this is not a permit and work is not to start without a permit;and that the work <br /> will be in acc ance with the pproved plan. <br /> / C �t Date <br /> �vser:ncs�,ea P�t 3iisioaj <br />