HomeMy WebLinkAbout1989-001997 - land alteration �F ORONO PERMIT TYPE:
�i Rd.South•P.O.BOX 66 Permit Number: � t
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CONTRACTOR: OWNER:
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APPL!C;�r,, 'iNE ISS ED BY:SIGNATURE
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�i�SPECTION RECORD
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd.South•P.O.BOX 66 Permit Number: �;��j�_�j�,��;�
Crystal Bay, Minnesota 55323 Date Issued: t��.:i'�'�:
(612)473-7357
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SITE ADDRESS: APPLICANT:
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PERMIT SUBTYPE: TI�PE ��' WcC'3�R��:���'
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' � CITY OF ORONO - BIII7�DING PERMIT APPLICATIOA
�tal Fee: $ Date Received:
Date Approved:
Entered By:
Permit�:
AT•T• INFORM�iTION MIIST B$ SIIBMITTF.D IN FITLL B$FORE PZ�AN REVIEW WII.L B$ STARTSD
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T� APPLICANT IS: (circle one) OWNER or CONTRACTOR
,
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JOB SIT$ ADDRESS: ��� �� ZIP: �J � � 7 f
,, (work)
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NAM�: OF OWNSR: �--CI� PHONE: (home)
.
MAIZING ADDR$SS: (> ' -��..�'i � CITY: ����� '��/ ZIP: -S�
f %`
CONTRACTOR: �- �� PHONE: �� ���
MAILING ADDRESS: �5� ' �' ` C Y: �i ZIP:��� /
�
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�
PROPOSED WORK (describe in detail) :
STORIES: SQ. FEST OF EACH FI.00R:
NO. OF B$DROOMS: GARAG$ STAI.LS: ATT. DET.
ESTIMATED COFSTRIICTION VALIIATION (eaclndiag land) : 1�$
I hereby apply for a building permit and I acknowledge that the informatic
abone is complete and accurate; that the work will be in conformance with t:
ordinances and codes of the City and with the State Building Code; that
understand this is not a Fermit and work is not to start without a germit; ar
that the work will be in accordance with the approned plan.
:� � ;�
APPLICANT'S SIGNATIIRE: � "� ��`� � � ��'� DATE: � � <
(Please fi 1 out the re rse side of this form)
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t CITY`o� O���T�
M Post Office Box 66•Crystal Bay.Minne+ota 5a323•Mnniripal O�cee
•
� - • �: On the North Shore of Lake Minnetonka
D�.��,P���P���
In accordance with M.S. I5.165, "Rights of subjects of data", we
woul.d like to inform you that your request for a permit or Zicense
from the City of Orono or any of its departments may require you to
furnish certain private or confidential information.
You are notified that:
1. The i�i n for1theypermit or Ii ensebrequesteg.determine your
quaZifica
2. You may refuse to supply data, but refusal may require that
the City deny the permi.t or license.
3. The information may be shared with other Iocal , state or.
federal agencies to the extent necessary to process the permit or
I.icense.
4. If your requested permit or license requires Council action
to approve, some information may become public.
5, You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your ful7. name, and date of birth are required to process
this application or permit.
- �---.. ._. �--- -- -�----
. -�- - �aaie-- -- � -
First
--- -- - - - Last
Addres�
. ._ ._ --._.... . .--- -Zi--- --
City State �P
Phone �
I understand my riqhts as stated above.
Signature
BUII.DiNG&ZONIIYG-473 7357 • ADMINISTRATION�FIIYANCE-473-7358 • PUBLIC WORKS-473 7359
ASSESSING
5
, - -
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� �, CHECR OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDRESS OR LEGAI. DESCRIPTION:
PID:
DESCRIPTION OF WORR:
------------------- ----------------------------------------------------------
ZONING RBVIEW BY: - DATE APPROVED: �-(z- ��
BDI7�DING REVIEW BY: � � .DATE APPROVED: b - I Z���
PERMIT ISSIIED BY: DATE:
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FEES TO BE CHARGED: Misc. Fees Calculated By:
PERMIT Yes ✓ No SEWER UNIT $
PLAN REVIEW Yes No SEWER CONNECTION
STATE SURCHARGE Yes�No WATER CONNECTION
PENALTY Yes No PARK FEE
SAC Yes No SITE INSPECTION
OTHER (specify)
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ZONING CHECR LIST Zoning District:
Fire Department: Post Office: School District:
Lot Area: Width: Depth:
Survey Submitted: Yes No Date of Survey:
Proposed Setbacks:
Front (Lake) : Right Side:
Rear (Street) : Left Side:
Adjacent Structures: Wetland:
Existing Proposed
Hardcover: 0-75 '
75-250 '
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: By: Council Approval Date:
Septic: Staff Approval Dates BY� "
Zoning File: # Resolution #: Resolution Date:
RF.1�lARRS (in house) :
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�3UILD PLA REVIE1r�t'
nvspe � � ! __
DATE/ � � 2� PSRMIT IvG, ___ _
�
APPROVED AS SUBMITTED ,
APPROVED WiTH CORRECTIONS AS Td.'-":�`
[j NL)T AFPROVED — CORRECT � �'��;;f,;
?hest comme�ts are for yaur infor�ra;�� f,ii M � ;a� �,��
��,c�Sj—' •� fi�l complla�ce with all appiicabie i:��, ��k R n,y� ctP a-
' er,�errts inef � n, items nu' spe� ,,, � ;�.- .. .. �r :,e�,; �tC�i�
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