HomeMy WebLinkAbout2007-A11681 user defined/general permit C.�.J i t.t/� c3' A aT2�'!?.�,ti""'`c1L �,v �u.T't.F- /1k K.+.�v- /
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�¢Q� City of Orono ; FOR CITY USE OlYLY
� P.O.Box 66
0 Q Date Received: /� Permit#A//lp S�
�� � � 2750 Kelfey Parl.tivay
s� I��i 4'`��- '` Crystai Bay,Mi�r 55323
��' �i�<<v�y��� (952)249-4600 Amount: $ C.U.P Filed:
��cr�ot`
Approved By: Site Plan:
Recommends: A roval ❑ Denial ❑
�"ITY" OF ORONO -USER DEFINED/GENERAL PERMIT
(All pennits must be approved by the Building Official and/or Zoning Department)
_7ob Site/Owner Information:
Site Address: �%�� �G�/'� Or
Owner: /�i��!'�Gtr� �aru�t sa�ne
Mailin� Address:
��ty: �n�u.� d Z�p: �5�y
Home Phone: y�v2"7 7����G Alternate Phone: �O�a"9��" p23�7
Co.ntractor/Applic'ant Information:
Contractor/App.: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
" ' " TYPES OF USER DEFINED PERTVIITS ` '
❑ Stairwav to Lake ❑ RetaininQ VValls
❑ Temporary Trailer
General—User Defined Surcharge General—User Defined 3urcharge General—User Defined
* (Per UBC) * (Per UBC) *�30.00
*Estimated Cost: S * Estimated Cost: �
❑ Docks—42"or Greater ❑ Land Alteration ❑ ZoninQ Review
General—User Defined Surcharge General—User Defined General—User Defined
❑ Commercial—(Per UBC) � 0-�00 Cubic Yards *ForO-75'Zone-�30.00
'� Estimated Cost: � � ��0.00(Needs Si�e Plan)
General—User Defined '
❑ Residential- �30.00 �5A:8��.U.p.�
❑ Tree Removal
General—User Defned
* 1�'ithin 0-75' -�30.00
I herby apply for a User Definzd Permit and I acl:nowledQe that the information above is complete and
accurate;that the work wil l be in conformance with the Ordinances and Codes of the City and with the State
Building Code; that I understand this is not a pennit and ��rork is not to start���ithout a permit; and that the
���ork i be in accordance ���ith the appro��ed plsn.
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Ap ican: __. _ Date
Resef Form c�Sz;D_�:,_�r_r,,,,,;�a;�s,