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--� <br /> .�,O��� FOR CITY,USE ONLY <br /> ` Date Received. ' ;--�>� �,;,�> Permit# ������'���� <br /> O O�l j Q ,�� )!� ,�` <br /> , <br /> (� �t�i�,,._, ,.; <br /> � <br /> ���, ��u / <br /> \��og/�/ Amount: $ C.U.PFiled: <br /> �� <br /> /� � � Approved By: Site Plan: <br /> tv � . <br /> � <br /> Recommends: A roval ❑ Denial ❑ <br /> �.�� r UF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> � Job Site/Owner Information: � <br /> Site Address: ,�(� `�t� �� S' G c� f�� /� <br /> Owner: ��d ;����,��-,��— Mailing Address: 5�--�"-`�—' <br /> City: 1���.��� Zip: �.S' �`� 1 <br /> Home Phone: �--�� ���7�,�� �� Alternate Phone: �.S'� ��`���� �/ <br /> Contractor/Applicant Information: <br /> � <br /> Contractor/App.: ;_���,-��_ Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> ❑ � <br /> Stairwav to Lake �� Retainin�Walls ❑ Temporary lrailer <br /> General—User Defined Surcharge General—User Defined Surcharge General—User Defined <br /> *(Per UBC) *(Per UBC) �.--� *$30.00 <br /> *Estimated Cost: $ *Estimated Cost: $�3,i�v � <br /> ❑ Docks—42"ar Greater � Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial—(Per UBC) � 0-500 Cubic Yards *Far0-75'Zone-$30.00 <br /> *Estimated Cost: $ $5�.��(Needs Site Plan) <br /> General—User Defined ❑ 501+CubiC Yards <br /> ❑ Residential- $30.00 $50.00(Needs C.U.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of tl�e City and with the State <br /> Buildin Code� that I rsta d th' ' not a rt and work is not to start without a pennit; and that the <br /> g _� <br /> work w�j��t c�ofdanc� . "� t�� ve"d plan. <br /> - -' - " ,.� _ � -���_� . <br /> Applicant ' � ` Date <br /> Reset Form �� c��ad��;x3�r$r�� <br /> .� ��,��a.�.����� <br />