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' Cit of Orono <br /> .¢,O� Y FOR CITY USE ONLY <br /> � � P•O.Box 66 Date Received: �' � �L�" Pemiit# ��� ��% �� � <br /> �;�,,,, 2750 Kelley Parkway � ' �'� <br /> I���'��:;'T- C stal Ba ,MN 55323 <br /> �' rY Y Amount: $ C.U.P Filed: <br /> �'�j,,��ri��y�` (952)249-4600 <br /> ���o$ <br /> Approved By: Site Plan: <br /> Recommends: A roval ❑ Denial ❑ <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All perniits must be approved Uy the Building Official and/or Zoning Department) <br /> ���Job Site/Owner Inf'ormation: �, €.;`����� <br /> ��s���� , � <br /> � , �:% <br /> ; /, <br /> Site Address: ; i � K-- <br /> � <br /> � <br /> Owner: i ��� <br /> �� � ���' " �(� ai '� ress: <br /> � <br /> City: � ,/�� Zip: <br /> Home Phone: ��j���,�� �-/" Alternate Phone: <br /> Contractor/Appiicant Information: <br /> Contractor/App.:-�T���/�� %//,/ ��11��ontact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Alternate Phone: <br /> TYPES OF USER DEFINED PERMITS <br /> � <br /> ❑ Stairway to Lake �Retainin Walls ❑ Temporarv Trailer <br /> General-User Defined Surcharge General-User Defined Surcharge General-User Defined <br /> * (Per UBC) � *(Per UBC) �) * $30.00 <br /> *Estimated Cost: $ * Estimated Cost: $J�f�/�-r�. <br /> ❑ Docks-One Time(tvor,-take n�ttka� ❑ Land Alteration ❑ Zoning Review <br /> General-User Defined Surcharge General-User Defined General-User Defined <br /> ❑ Commercial-(Per UBC) ❑ 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.) <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 /> accura�that the wo�ic will bej�onformance with the Ordinances and Codes of the City and with the State <br /> Bu-rTding(:ode;th un an ' is i not a permit and work is not to start without a ermit;and that the work <br /> ��vill be i accozdanc. ith ap rov plan. <br /> � <br /> � <br /> plicant i Date <br /> ttr�cr txsa�e r�nt osros�a9� <br />