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