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OCT-10-2006 11 :29 AM Macalester_Bioloey 651 696 6443 P. 02
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<br /> . � � P.O,Box 66 ' • • �a C UffiE OIV�'��';. ; • �• .
<br /> • � � I750 Kelley Perl�vay Dare Reeelved: ,�� P�m�ic�I '� �1�
<br /> � ' �� (g52)Z 9-460MN 55323 , �/ � . �;'j :�, ;;; .
<br /> .Amount: S ���i •a C.LrP Filbd�
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<br /> Reoominenda: roval . D'oni11'�: .
<br /> CITY OF ORONO-USER DEFINED/GENERAL PE�tMIT ` '
<br /> (All permits muat be approvod by�he Buildinp Ot�fcial end/or 2oninB Deportmant) �
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<br /> Si�e Address: o�e, r,��. �
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<br /> Owrier, Mailing Address: S �t�oe ;
<br /> City: V r'8v�O '
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<br /> Home Phone: �5 � ���s� Alternate Phone: C �5( � I� ,
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<br /> Contractor/A,pp.: s S ��- Contact Person. �� h�
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<br /> Address; ���� s l � � State��eense#: —
<br /> ci�y: a � z�P: 5�'3Ga ��c��: — ` .
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<br /> Phone: �6 �+5 Alurnate Phone: �/ ��Z- Q� i� �
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<br /> :+J:�:�e::r::�:t1.��'s$:�� ��';:5'ii`;ir;� 4�ii�:'�:i•.}�-0/17�.0�. ' S ''''' ,��:l�' ;:,."�:13�r ;i,ry �' �
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<br /> [] $�i�v�y to Y.ake Retaining Walls I er
<br /> Generel�Uoer Defu�ed Surcherga �Ge�aral-Uaer Dafined Surchetge ❑ Qene�1-User Db �
<br /> "(Per UBC) i(Per tJHC) '/ +530.00 ! �
<br /> *Estimated Cost:S__ +Eetlmated Cost;S�7_ ��_ ? i
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<br /> ❑ L?Qcks-42"or Greater ❑ Land A(Yeration ❑ Zo '
<br /> Genonl-Uur Defined Surcherge Geaeral-Uaer DcFined �
<br /> � ❑ Cocnmereial- er U�C c�ene�J-User� e
<br /> (p ) Q 0-500 Cubic Yards w For0�75'Zone 0.00
<br /> *Eatimated Coste $ 550.00(Needs 3ite Plen) ,
<br /> Ceneral-UserOefined ❑ SO1+Cubic Y��ds I ,
<br /> ❑ Residential- S30.00 SS0.00(Neada C.U.P.) '
<br /> ❑ Tree e v � .
<br /> (3eneral-User Definad
<br /> *Within 0-75' -S30.00
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<br /> I herby apply for a User Defined Permit and I acknowledge tl�at the infotmation above is comple ttd ,
<br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and with th ate
<br /> Building Code;that I understand this is not a permit and work is not to start without a permit; and tt� the I
<br /> will be ' a rdance with the approved plan. ;
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<br /> Applicant ,, :...,... ,.,, . , : . D ' �
<br /> , �, . Res ��Form . n�w�� �, �
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