HomeMy WebLinkAbout1996-008610 - reshape pond �, PERMIT
'' CI�'Y OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 � ��_�` `..���-��J.`��=.C�
Crystal Bay, Minnesota 55323 Permit Number. ;�_��,;-;�.,�;:;
(612) 473-7357 Date Issued: -,;;��,�,,.�,;,�,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: -�- ����=���: i c.�a�t. — OWNER:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATURE
+ CIT� OF ORONO � 6124730510 12/04/96 12:33 �1 :02/03 N0=410
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Total Fee: $ Date Receiued:
Entcred By: Pcrmit A�:
CTl'Y OF ORONO - BUILDING PERMIT APPLICATION
All iaformation muet be submttted in 4ti11 be!'ore pian review w(q be startcd.
(please print all informarion)
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� THE APPLICANT IS: (ci�cle one OWNER OR ONTRACTOR
�
� JQB SYTE ADDRESS: Z�cI � SO�'`�'-�`-°�-� L �^�____ ZIP:
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NAME OF OWNER: �c C �C. ��fa-w�r/l. PHONE: (home)
(work)_
MAILINC:ADDRF:SS: .S�w��. o� /��, CITY: ZIP:
CONTRACT(�R: Q o��-� � +-S o Ns PHONE: ��3�S-�J f 3 3
�-. CONTACT PERSON: N N ELso N MOBILE/PAC H:R: 7 z�- `�oo g
� ING ADDRESS: �I o 1 Lo u.Hrt'Y�o CITY: �-�-o �N S ZIP: S 5 3 y 3
MAIL
STATE LiCEN5E: p
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ARCHITECT/ENGIfiTEERi' .. ... .'�^I,I' y rAO�.
11�AILJNG ADDRFSS: _ "`,,,__
�Y� .....�_CITY: •
NAM�: � `''.-RF�YST1tATION a
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TYPE O�'WORK: New Addidon Accessory Structure
Move Remodel/Alteradon I.and Alterat9on
-�.PROPOSED WORK(describe in detain: 11�.�.�--r}-�_�- ��`^'` �'O`^
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-_.__.-.�. SQ.FEET OF EACA � r--'-.-"__
STORIE9: �- _ �
NO. OF BEDROOMS: � TALLS: ATT. DET.
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ESTiMAT STRUCTION VALUATION(excT�Tdi and): $
I hereby apply for a building permit and I acknowledge that the information bove is complete and
accurate; that the work will be in conformance w�th the ordinances and codes of the City and with
the State Building Code; that I undtrstend this is not a permit and work is not to start without a
permit; and that the work wil! be in accordance with the approved plan.
APPI.ICA.NT'S SIGNATLTRE: /1� . DATE: �a`� `�
NQTE! P��� of Hnmes everits reguire separate permit approvat by Pol�ce Department and
C�ty Councu'60 days privr to the event. Non perrn�lted events wllt not be allowed.
CITY OF ORONO � 6124730510 12/04/96 12:33 � :03/03 N0:410
� .'�.
Sec,l3.04 RIGH7'S OF SUEITECTS 4F DAT,1
Subd. l. Tyye of daa. The rith�of individuzl on whom rlie data is s�oced or to be 9�orsd shall be as�ei focth in this sccdoa.
Subd.2. Ia[ormatioo required to be giren indlridual. M indlvidual asked to supply pri�ace or co�dendal dau cancerning Eimsetf shall
be infontied of: (a)the purpose�nd imm�ded use ef�he rcqucsced dara wlthin the eofleccing Y�ate agency, policica!subdivision,or sucewide syscem;
(b)whe�hec ho may rtfuse o'r is legally rrquircd io supply rhe cequested dsta;(c)utY fcnoum consequence arising frnm his supplying or refusing to suppty
p�vaee or contldencial dan:and(d)dte iden�iry uf o�her pccsons or enriries tu�horizr,�l by sn[e or feder�113w ta rtceire the dAta. This requi[emen�shall
not apply whon an individual is asked w supplv in�esdgadvc da�s, pursuant to secuort 13.8?, subdivixion 5, to a liW enCorcement otfieer.
�� �•pmm���ioner of revenue mnv pIOC� the narice reuuired under�l+is �ubdivislon in �}+� indiY�duol ir�urte ux�,�,eca�e[tv tnz re_funG_
�istruccion9 inYceaqyl on�hos�loccns•
Subd. 3. Access to data by indtvlduai. Upon reques�t�a responsible auchoriry,an indi�i3us1 shnil De lnformtd whether he is the subject
of s�orrd Jan on individuale,arui whe�her i�is dassified as public.pri�a�e or canfldtntial. Upon his fuRhcr requesc,an individuel who is ehe subj�ee
of s�ared pri�a�e or public dau on individuals shstl be shown�he dara wichou�any cha�e co him�nd, if he desires, shaU be infortned oP fie eancone
and meaning of�hai dar�. After�n individual has been showrt the prlv�u dav and inPormc�i of its me�nin�,the da�s need not be dltclo9cd eo him for
9ix mon�hs ehereuAer unlc�s a dispute or ncriun punusnc eo�his seetion is pending or addia�nal da�on�he indi�idunl has heen cofte^ubferau�hon�
'Ihe tespon�ible�uthonry shall providc copies of che privaa or public dan upnn request 6y th�individual subjocc of the da�a. The resjw ry
m�y require rhe requss�ing person�o pay �he acn,al coscs ot rr,�king,ceRifyins,and compiting �he copies,
The rasportsible ait�honry shall comply immediately, i(poesible,with any request made pur5uant to rhis subdivision, or witl►in five diys of
yo dat�of i2te request,exclu�iln�Sacurd�ys,Sundiys ind legal hulidays,i!lmmedia�e eompliance�s nat poesible, if he csnaot comply with�lte reyucs�
wiNin rha<«me,he shnll so info�m�he indlvidual,and may have�n addirional l�ve days wichin wRieh�u corn�ly Wi�h che reques�,excludin�5acuniays,
Sund�ys and legsl holid�ys,
Sqbd,b. Procedure when dota is aot aecurote ar complete. An Individual may conteu the eccuracy�r comple[eness oF publie or priva�e
d�n cuncerning himself. To exercise this ngh�.an individual shall no�i[y in wricing�he responsible authoriry describing�hc nature of�he dl�agreemant.
Tho reaponsible au�horiry shall widiin 3U d�y�eieher: (�)correct[he dan Pound ro be inaccurace or incomplece and aaemp�co nocily pasc recipienu of
inacaurate or Incompleie daru. Including reeipienis name�by d►e individual;or(b) notiEy�he individual thai he believes�Ile dara to be correc�. Dan
in dlspuco shxll be disclused artty if�he iruiivid�,al's sra�emen�of di�agreemenc is included wich ihe Aisclosed dara.
'Che dctermination of the rasponsible auil,o�iry may be appcaled pursuan�to ihe pro�isians of the odminirtrarive procedure act relacing co
eont�sted caAes,
DATA PR�A�X ADV�SORY
In accordance wich M.S. t3.04, Subd. 2, "Righcs of subjects of data",we would like to inform you that your request
fqr a permic or license from the City of Orono �r any of its departments may require you to furnish ct�tain private or
confidential information.
You are aotificd thac:
�, The inforrnation you furnish will be used to deeermine your qualification for the permit�r license rcquested.
2. You may refuse to supply daca, buc refusal may require �hat the Cicy d�ny che permic or licensr.
3, 'The infotmation may be shared with othe�local, state or fcderal agencies to the ertenc necessary co process
the permit or license.
4. If your requested permic or licanse requires Council action to approvc, some information may become
public.
5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6, Your full name !s required co procoss this applicaeion oc permi�.
�,�N ,e� I��R�,N IN ��s6�
M�a►� �:�
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� ��o� C���N-rY n
Aaa�=� _rdl� .lJ-�3�(3 �'3 �—�(3�
� r`'s /JJ Phonc
Stats 7.ip
Ciq�
i understand my rights as staced above.
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