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�, <br /> O,¢D�O City of Orono FOR USE ONLY <br /> P.O.Box 6G Datc Received:/'m� Pe+mit# � ��� <br /> 2750 Kelley Parkway <br /> ����� Crystal Bay,MT155323 Atttoupt: $ C.U.P Filed: <br /> 4 (952)249-4600 �q <br /> Approved By: f V. Site Rlan: <br /> i �� • <br /> Recommends- A val Deaial ❑ <br /> /Ua p�.►bJp �'tr�'.�� <br /> C`ITY OF ORONO-USER DEFINED/GENERAT.PERMIT <br /> (All pecmits must bc approved by the Building Official and/or Zoning Departmcnt) <br /> a a-' �v k :�«-_,; > .�-y �„ , ,. <br /> ��• ,��„, � ,� 5 wt� <br /> �,�.�.,.�ri � `��� .b r� <br /> Site Address: j300 �m�'`"°� '��`x� ,�'v"� <br /> Owner: �se� �u+�5 r�,�+� Mailing Address: /3�U �w� L�'�c�A �-��e <br /> City: V Y'a+? d Zip: �3 6�1_ <br /> Home Phone: �o l7�Z 3�1'-� �l Sf S� Altemate Phone: <br /> ��`U�. �y���� �^�. ���t10 � ��`�Y' <br /> ,+w.. i,s� - .�r T.< r �':h4 tl't L. <br /> Contractor/A�p.: (�_�C� Contact Person: ; <br /> i <br /> Address: State License#: � <br /> , � <br /> � City: Zip: Expiration Date: <br /> Phone: Altemate Phone: <br /> a_;f�'ae� ,w� :!��'� � ��� x.►�', ��� ��� � � �,;�'���.�•`� i. ,��; y� :�''-'� :I�q <br /> '-i' 1. -i�. 5 <br /> ❑ Stairway to Lake ❑ Retaini�Walts ❑ Temporary Trailer <br /> � General—User Defined Surcharge Gcneial—User Defined Surcharge General—User Defincd <br /> *(Per UBC� *(Per UBC} *$30.00 <br /> *Estimated Cost:$ *EstimaEed Cost:$ <br /> ❑ Docks-One Time rnton-�t�r�tu�) �Land Alteration ❑ Zonin�Review <br /> Gcneral—User Defined Sarcharge Geu I—Usa Befined General—User Definod <br /> ❑ Commercial-(PerUBC) 0-500CubicYards '�ForO-75'7.ane-$30.00 <br /> *Estimated Cost:$ $5fl.00(Needs SitePlan) <br /> (3eneral—UserAefined ❑ SO1+�bicYards <br /> ❑ Residential- 530.40 $50.00�eeds C.U.p.) <br /> ❑ Tree Removal <br /> Geaeral—User Defined <br /> *Within 0-75'-$30.00 <br /> I herby apply for a User Defined Pemvit and I aclrnowledge 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 Co , aR I erstand this is not a perrmt and work is not to start without apermit;and that the work <br /> will be ' cc da 'th the approved plan. <br /> �Z-3- �9 <br /> Ap �can Date <br /> ���'�:Q�� <br />