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O•�O�O Ci of Orono r ONLY <br /> P.O.Box 66 Date Received: ��d tl, 'Permit# <br /> W4,...,n r 275 Kelley Parkway /(�{�OS <br /> 7 Crys I Bay,MN 55323 <br /> �+ i v~� (952 249-4600 Amount: $ C.U.P Filed: <br /> Vit <br /> Approved By: Site Plan: <br /> Recommends: Approval Denial 0 <br /> ITY OF ORONO -USER DEFINED/GENERAL PERM T <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site:!Owner information. <br /> Site Address: I C b 6 f G',t'° 0/4cKr' )64 <br /> Owner: :4' P4 i4 e Mailing Address: <br /> City: Lo,4v6 '4K'- Zip: 5 3S- ee, <br /> Home Phone:w( > 96 `%" (.4'GQ Alternate Phone: <br /> •5 Z • 41-7 3 —?./C 1252, <br /> Contractor/.App 'ic""ant Information: <br /> Contractor/App.:j Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> . . TYPES OF USER DEFINED PERMITS <br /> ❑ Stairway to L ke ❑ Retaining Walls ❑ Temporary Trailer <br /> General—User De ned Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) * (Per UBC) *$30.00 <br /> *Estimated C st:$ *Estimated Cost: $ <br /> ❑ Docks—42" r Greater X Land Alteration ❑ Zoning Review <br /> General—User De coed Surcharge General—User Defined General—User Defined <br /> ❑ Commerci -(Per UBC) p 0-500 Cubic Yards *For 0-75'Zone-$30.00 <br /> * Estimated Cost:$ . $50.00(Needs Site Plan) _, <br /> General—User Defined ❑ 501+Cubic Yards ____ <br /> ❑ Residential $30.00 $50.00(Needs C.U.P.) lb I Z f l C.--(/ / ve t <br /> ❑ Tree Removal' VC c <br /> (-111171? `� Gy _ <br /> General—User Defined ""�--- <br /> * Within 0-75' $30.00re 1 - pi a ii i-n h ve Ce'�(S'so��" <br /> I herby apply for a User Defined Permit and I acknowledge 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 understand this is not a permit and work is not to start without a permit; and that the <br /> work' ill be in accordance with the approved plan. <br /> K- p <br /> Applicant Date <br /> Reset Form (UserDe nedPermit 3115r04) <br />