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� ,��� City of Orono FOR CITY U5E ONLY <br /> 0 0 P.O.Bo�66 Dzte Received: �_//"uj Permit# �d�YU� <br /> �i;,•,, '7�0 Ke11ey Parl.�-ay <br /> a il�''�'y � Cr s[al B2 MN 55_2= <br /> � t:�',14`,:"' � Y Y, Amount: S__�y�.U.P Filed: <br /> `�t'$`'y�Jl;i�q�`.� �952)2a9-4GG0 <br /> 't'�&8e��/ APPro��ed By:�/��� Site Plan: ']•21—�S <br /> Recommends: A rova Denial ❑ <br /> CITY OF ORONO - USER DEFI?�ED/GENER�.L PERIVIIT <br /> (Ali penni�s must bz approved by die Buildino Official andior Zonine Deparcment) <br /> JoU Site/O��nier I�iforniation: <br /> Site Address: ���� 'v��� ��Q r� �r► � <br /> Owner: �� ►'Y1�` 1 � � �� ���1'1`�Iailina Address: ��'� <br /> � � <br /> c�ty: (�rQ�� z�p: 55'�q I <br /> ���a - �1 �d -io c� i�� <br /> Honze Phone: S �' Alteniate Pl�one: L�1 Z— � �U -CJ ��a <br /> Conh-actor/Applicant I�Zfomiation: � � � <br /> �.� <br /> Contractor/App.: n act Person: <br /> Address: State License �: <br /> City: Zip: Expiration Date: <br /> Phone: AlteilZate Phone: <br /> i TYPES OF USER DEFINED PERNI�TS <br /> �Stain��ay to Lal:e ❑ RetaininQ Walls ❑ Tem�orarv Trailer <br /> General—User Defined Surchar�e General—User Defined Surchar�e General—User Defined <br /> * (Per UT3C) * (Per UBC) x $30.00 <br /> *Estimated Cost: � �OC>u �C7V *Estimated Cost: S <br /> ❑ Dock;—4?" or Greater ❑ Land Alteration ❑ Zonina Review <br /> G�neral—liser Dztined Surci�aree Gzneral—Us�r Detined Generai—User Detined <br /> ❑ Conunercial—(Peo-UE�C) ❑ 0-�OC Cuoic 1'ards *ForO-7�'Zone-�30.00 <br /> * Estimated Cost: � 550.00 (:�eeds Si�e Pian) <br /> General—U;:r Delin2d ❑ 501+CubiC Yat'ds 1 <br /> � Residential- �30.00 �SOAO (Ne�ds C.U.r�) � <br /> ❑ Tree Removal �,���/ <br /> Uv' ��(�,{. <br /> General—User DeEned Ci `" <br /> �` W ithin 0-75' - 330.00 <br /> I he.by apply for a User Defined Peiznit and I ack7:owledQe that the information abo��e i: comp:ete ai;c <br /> accurate; tnat the work«�iil be in confornlance wiih tize Ordinances ana Codes of the Ciri�and�vith the State <br /> Btulding Code;tnat I uncerstand this is not a pe?znit and work is not to start wifnout a permit;and that the`vork <br /> �v:ll be in acco-dar.ce ���itn the approved plan. <br />