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, i � <br /> �,¢�� City of Orono FO CI Y USE ONLY <br /> � P.O.Box 66 <br /> �,� 0 DateJ �i�/a: Permit€t <br /> h. � 2750 Kelley Parlcway <br /> �, �11�,��%., k Crystal Bay,MI�r 553'•'3 <br /> ��' n'ht ;�i��y�� (952)249-4600 Ainount: $ .� <br /> \��04 ' � C.U.P Filed. <br /> Approved By: ��?1�l,�,��.,�Site Plan: <br /> (�„�...,. _ <br /> Recommends: A roval Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENER.AL PERMIT p�� '"^'�'`�" `'`'T <br /> (All penniu must be approved by the Buil ding Official and/or Zoning Department) P�R'�'K'� <br /> Job Site./Owner Information.� , `' <br /> .. . ,. <br /> Site Address: ��� • <br /> � <br /> Owner: �d ����in� Address: C�� � <br /> City: � • Zip; ,���— <br /> Home Phone: �f 7! ���� Alternate Phone: f <br /> 'Contractor/.Applicant Iriforrnation � �~ <br /> Contractor/App.:��/�itfG� �pLjI�Q–�ntact Person: ' <br /> ��l�sl� s� <br /> Address; , State License#: ��2L1/��d?! C� <br /> 1�$��— m 1� A.�q � <br /> City: �__ Zip: �� Expiration Date: �� <br /> � � <br /> Phone: _�7l •-��-5� Alte.rnate Phone: <br /> _"_� TYPES OF:USERDEFINED PERMITS :: =N 4 ,` <br /> � � <br /> ❑ Stairwav to Lake ❑ Retainine Walls ❑ Temporarv Trailer <br /> General—User Defined 5urcharge General—User Defined Surcharge Genera(—User Defined <br /> * (Per UBC) * (Per UBC) *�30.00 <br /> *Estimated Cost: $ *Estimated Cost: � <br /> ❑ Docks—42"or Greater �Land Alteration ❑ ZoninQ Review <br /> General—User Defined S urcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) C7 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> * Estimated Cost: $ ��0.00(Needs Site Plan) <br /> General-Uscr Defined ❑ 501+ Cubic I'ards <br /> ❑ Residential- $30.00 $50.00 (Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Def ned <br /> * W ithin 0-75' -�30.00 <br /> I herby apply for a User Defined Permit and I acl:nowledge that the infonnation above is complete and <br /> accurate;that the work 'll be in conformance with the Ordinances and Codes of the City and with thz State <br /> Building Code; that I nderstand this is not a permit and work is not to start ���ithout a permit; and that the <br /> ���ork ���' 1 e in acc danc with the spproved plan. <br /> � � `l!� 8`°ti <br /> Applicant _. Date <br /> sef Form (Use,-DeF�edFe+mii;;�a;�.� <br />