HomeMy WebLinkAbout1991-003677 - land alteration � I'ERMIT
CITY OF ORONO PERMIT TYPE:
�'335 Brown Rd. South • P.O. Box 66 ��' '�`� ���j���C�
_, Permit Number: {��j;;i�,7;
• rystal Bay, Minnesota 55323 Date Issued: tx�/13��i:.�f
( 2) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
r CITY OF ORONO - BDILDING PERMIT APPLICATION
To�al Fee : $ Date Received:
Date Approved:
Entered By:
Permit#:
AT•7• INFORMATION MIIST BE SIIBMITTED IN FIILL BEFORE PLAN REVIEW WILL B$ STARTED
(See Check-off List Enclosed )
------------------------------------ -----------------------------------------
THE APPLIGANT IS: (circle one ) N�� or CONTRACTOR
Jos szT$ AnDx�ss: ;�7 �! � S ; ! ��� L� � � �� (� �' _ ziP: S` S 3s.6
(work)
� PHONE: (home) y 4 � -�'"��
r� oF owrT�x: -�� �v� �e�` <<; -.3 : I-1 ��
MAILING ADDRESS: � � �1 L ✓i �VC(� U l F w � CITY: �� i �' (1� ZIP: S �3 S �
CONTRACTOR: -� �Y1� Lc�...�:G G�l�,� PHONE: y 7 Z- 7 7 c6
MAILING ADDRESS : ;�, (.j, �� a � � CITY: �ll��� ��� ( ZIP: S S3� �
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration�
/� � r
PhOPOSED WORR (describe in detail) : (�-Y'�.Q ��c�.�(�- v'C�- Cte.wc,� �J
� � b� �� � �t��-c a: �z�w U�� � � � �( � a'4-� I � ,
STORIES: SQ. FEET OF EACH FLOOR:
AIO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRIICTION VAI�IIATION (ezcluding land) : $
I hereby apply for a building permit and I acknowledge that the information
above is complete and accurate; that the work will be in conformance with the
ordinances and codes of the City and with the State Building Code; that I
understand this is not a permit and work is not to start without a permit; and
that the work will be in accordance with the approved plan.
� � �
APPLICANT'S SIGNATORE�,i �'�' /' /� � �� DATE: L�- Z 5 c//
� � ''� CHECR OFF LIST FOR ISSIIANCE OF PERMITS
FOR OFFICE USE ONLY
ADDR$SS OR I.EGAL: PID:��3 - /I�'o'�3 � 02 ���,
DESCRIPTION OF WORR: G� ���.
------------------------------------------------------------------------------
ZONING REVIEW BY: ��e,� _y►.�� _ DATE APPROVED: S-6 •c1I
BIIII,DING REVIEW BY: /�J I I'� DATE APPROVED:
------------------------------------------------------------------------------
FEES TO BE CHARGBD: Misc. Fees Calculated By:
PERMIT Yes r/ No
PLAN REVIEW Yes No ✓' SEWER CONNECTION
STATE SURCHARGE Yes �'! No WATER CONNECTION
INVESTIGATION FEE Yes No�� PARR FEE
SAC Yes No � SITE INSPECTION
Number of SAC IInits OTHER (specify)
-----------------------------------------------------------------------------
ZONING CHECR LIST Zoning District:
Fire Department: Post Offic�: � Schoo1�D istrict:
� --? �
� Lot Area: Width: i' Depth: ! f
Survey Submitted: Y s� No Date of Suxfbey: �/ '
�'
Proposed Setbacks:,� '� �
Front (Lake),� `/ Right Si�e: ' _
Rear (Stre�t) : ;; %/ Left S�:de: '
,
�
Adjacent Structures : � �"� Wetland:
� �
Building Hei,z�ht: Def. ; Hgt.% Peak Hgt.
N , _--
Avg. Setba,ck: % �� Lot���ierage: �
Ex�.st ng ��Proposed
l' � _
Hardcover: 0-75 ' ' ;'t , '
/
;: , �."
�"
75-250 ' � ,'
/ %' �
� 250-500 ' �'� '�
� �
500-1000 '
Hardcover Variance Required: Yes No Date of Council Approval:
Grading: Staff Approval Date: S"6 -G � BY�.�F�"_ouncil Approval Date:
Septic: Staff Approval Date: BY:
Zoning File:# Resolution #: Resolution Date:
RBMARRS (in honse) : -
BIIII.DING REVIEW Ct3BCR LIST � . �
.
IIgC� CONSTRIICTION TYPE: •,
Sq Footage $ Per Sq Ftg
Basement X -
lst Floor X -
2nd Floor X -
Garage X -
x =
TOTAL -
Estimated Construction Value: $
Inspections Required: Work Requirinq Separate Permits:
Site Plumbing Grading/Filling
Footing Mechanical Fire
Framing Septic Water Connection
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
Final (Mfg. ) Well State Permit
Other Electrical (State Permit)
RBMARRS (IN HOOS$) :
----------------------------------------------------------
REVIEW BY OTHERS: DATS:
Access: Existing New
Access Approval: Date BY=
------------------------------------------------
R$MARRS (TO B$ NOTSD ON PERL�IIT) :
! • .�:'�'n"'"`�.,.
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"�"`,9: �\ ��'F5� .�il.
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S.,.i�:e.� -=
£�}4'� � � Post Office Box 66•Crystal Bay, Minnesota 55323•Municipal Offices
:�"` -
3'"
� s � � ,�; On the North Shore of Lake Minnetonka
DATA PRNACY ADVISORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of
data", we would Iike to inform you that your request for a permit or
Iicense 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 information you furnish wil.l be used to determine your
qualification for the permit or Iicense requested.
2. You may refuse to supply data, but refusal may require that
the City deny the permit or Iicense.
3. The information may be shared with other iocal , state or
federal agencies to the extent necessary to process the permit or
license.
4. If your requested permit or I.icense requires Council action
to approve, some information may become public.
5. You have certain rights under M.S. 13.04 to review prica��
data on yourself.
6. Your full name is required to process this application or
permit.
` ' ���e�� _ � � I � ( �e
First Middle Last .
oZ�1 � � �,� � ve � Vi �w .b ✓' -
Address
� f0 ��v � � 5�35G
City State Zip
�.�y y -d v � /r
Phone
I understand my rights as stated above.
,
, �
�.� ><�;
` Sign ture
BUILDING&ZONING—473-7357 • ADMINISTRATION&FINANCE—473-7358 • PUBL[C WORKS—473-7359
ASSESSING
. �
�.� �Gg� �g y�g�7ECTS OF DATA
Subdivision L Type of data- The rights of individuals on whom the data is
stored or to be stored shall be as set forth in this section.
Subd 2. Information required
to be given in�v��' An.individual asked to
su 1 private or confidential data concernina �$mWi hin the collect g state agencY,
PP Y
purpose and intended use of the requested from his
tem; (b) whether he may refuse or is legally
political subdivision�he request d da; (c) any known consequence arising
required to supp y rivate or confidentiel data; and (d) the identity of
supplying or refusing to supply p
other persons or entities authorized by statu��e�kedlto supplyenvest gat ve da a
requirement shall not apply when en individ
pursuant to section 13.82, subdivision 5, to a law enforcement officer. under this
The commissioner of reven��or ropert tax re�und instructions instead o
subdivision in the individual incom�
on those orms. . --- - .
Subd. 3.
Access to �ata bp in�ivid�81- UPon request to a responsible
authority, an individuel shall be informed whether h=�gteeor confident al.e Upon his
individuels, and whether it is classified es public, p ublic data on
e to him and, if he desires, shell
further request, an individuel Who is the subject of stored private or��u� has been
individuels shall be shown the date witho of�hat da a• After an indi
�e informed of the content and meaning the data need not be �sclosed to
shown the private dats and informed of its meaning, u�uant to this section is
him for six months thereafter unless a dispute or action p
rivate or public data upon request by
ending or additional data on the individ�h hes been collected or created. e
� p rovide copies of P uire the
responsible authority shall p �d compiling the
the individual subject of the c��'cos h of making,l cert fyingy may re
requesting person to pay the a _
copies. y if ssible, with any request
The responsible authority shall comply immediatel , Po
made pursuant to this subdivision, or withinlaa e �f Simmediateatcompliance e��.su not
excluding Saturdsys, Sundays and legal hol ys,
ossible. If he cannot comply with the request within that time, he shall so inf�orth t�e
P haye sn additionel fi�e da}'S Within which to comply
individual, and may 5��� �d Iegal holidays.
request, excluding Saturdays,
te or complete. An individugl may
Subd. 4. Procediu'e when �ata is not accura �mself. To
contest the accuracy or completeness of public or private �tthe�responsible authority
exercise this right, e.n individual shall notify in writing
describing the nature of the disagreement. The responsible authoi t �a at pt to
days either: (a) correct inaccurate ordincomplete datae including recipients named by
notify past recipients of
the individual; or (b) notify the individual that he believes the data to beement is
Data in dispute shall be disclosed only if the individual's statement of disagr
• included with the �isclosed data• � BQPe�ied pursuant to the
' The determination of the responsible authority may
provisions of the administrative procedure act relating to contested cases.
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