HomeMy WebLinkAbout1996-007591 - pond . PERMIT
� CITY OF ORONO PERMIT TYPE:
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2750 Kelley Parkway- P.O. Box 66 �
Crystal Bay, Minnesota 55323 Permit Number: i'�i;�r°�
(612)473-7357 Date Issued: �,y��/;�� ��_��:,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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APPLICANT/PERMITEE SIGNATURE ISSUED BY:SIGNATUR � �'-� ,
� DateReceived: ; ' �
Tota1 Fe�: S ;%•" ^<'
Date:�pproved:
� Permit": ����ti�
En�ered Bv: �-�.,
CITY OF ORO�+O - BL�LLD�tG PERNIIT �PPLICATION
�I.L ��'OR1tiI�TION l IL ST BE SUB�1I�fiED L�t FLZL BEFORE PL��T REVIE�V ti�II.,L
BE ST:�RTED
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T� �PPLIC�v�'T IS: �circle one) O`V�ER R CO�tiTR�CTOR
1 zg': '�'j�j5 (a
JOB SITE �DDRESS: �� �(�; ���'� `--�'`��
r1��TE OF O�V�`ER:
� PHONE: (home) �5�-�o`f"3
(�z�or�) 3�-7- 4�
11AIL�G�DDRESS: eS1n�y-t- �� CITY:�v��ZIP:�`��O
e� Pxo�: 4-�t0._ (��3�
CONTR�CTOR: �Obe.1'��: C�-rC�q I�OBILE PHO�+�E/P�GER: �1-^1�%i`j
�c r-�e� �CITY:`��cr e.t:.;�.-� ZIP: `�J��I
�I�IL�'G�D�SS:22��� �
ST:�TE LICENSE: � `�6�`��
�iZCHTi'ECT/E�GL��EER: Co��;v��(-�.����,�s..pxo��: �� 3-`�l41
� CITY: Lov� �ZIP: �j`=�3`7�o
�It�LI.L�G�DDRESS: ��Z -T�,,�v,r�a�1� /�� REGISTR� �i n 2'�7��j
NA.:vIE: �u
TYPE OF `�'ORb': Ne�v Addition Accessory Structure
ne::ode!�:�.lte:�tion T�d Ateranon �
Move �
PROPOSED`ti'QRhldescribeindetail): �' o p-- � ��"x`'"��'w`
�� �,,_.a.Y..s- C�,�,�..�.� ,3 `� .
STORIES: � SQ• �ET OF EACH FLOOR:
�O. OF BEDROO�IS: G�R�GE ST�I.LS: �TT. DET.
ESTLtiI�TEDCONSTRi;CTIO\V:�LL:�TION(eYcludin�land): S
I hereby apply for a buildina permit and I ac?cnowledQe that the iniormation above is compleie
and accurate; that che work will be in conformance with the ordinanees and codes of the Ci�y'
and with the State Buildin� Code; that I understand �nis is not a permit and work is not to start
without a permit; and that the work wiil be in accorda�ce �vith the approved plan.
1��1� ���
�iPPLIC��'T'S SIG�tATLTRE: �c:�0�- �, ��� DATE: .
��'OTE! Parade o Homes events require separate permii approval by Poliee Department and
Ciry Council 60 days prior to the event. Non-pernruMe� �i�ents tiNill not be allowed.
. �
Sec.13.04 RIGHTS OF SLBJECTS OF D�1T�,
Subd. l. Type of data. "Ihe riehcs of individual on whom cbe data is stored or to be stored shall be as sec foc-[h in this secdon.
3ubd.2. Information required to be�ven indicidual. .�n individual asked to supply priva[e or confidenaal data concerning hunself shall
be informed of: (a) the purpose and in�er.dzd use oi the requested data wichin the collecdng'state agency, polidcal subdivision,or stacewide syscem;
(b)whe[her he may reruse or is legally required to supply�e requested dara:(c)any Itnown consequence arising from tus supplying or refusing to supply
private or confidenoal data:and(d)the idendry ot o[hez persons or enddes authorized by sta[e or federal law ro receive the data. This requiremen[shall
not apply when an individual is asked ro supply invesnganve data, putsuanc to sectio❑ 13.82, subdivision 5, to a law enforcement o�cer.
The commissione of reverue mav olace �e nonce -eauired under �his subdivision in the individual income taz or oropertv taz reTund
ins�ructions insread of on those forms.
Subd. 3. ?,ccess to data by individual. lioon reques[to a responsible auchority,an individual shall be inYormed whe[her he is the subjzct
of stored data on individuals, and whecher it is classitieai as public, pnva[e or contidennal. lipon his further request, an individual who is the subject
of stored pm�ate or public data on individuals shall be shown [he data without any cnaree to him and, if he desires, shall be informed of[he concenc
and meaning of that data. :�fter an individual has been shown[he private data and informed of its meaning, the data need not be disclosed to hirn for
six months thereatter unless a dispute or action pursuane to [his secnon is pending or addidonal data on the individual has been collected or crea[ed.
The responsible au[honry shall provide copies of the pma[e or public data upon request by rhe individual subjecc of the data. The responsible authority
may require the requestine person to pay [he actual costs of makin2, cemfyine, and compiling the copies.
The responsible authoriry shall comply immedia[ely, if possible, wich any reauest made pursuan[to this subdivision, or within five days of
the date of the request, excluding Sa[urdays,Sundays and legal hofidays,if immediace compliance is not possible. If he cannot comply with the request
wi[hin tha[time,he snail so inform[he individual,and may have an addidonal five days within which ro comply with the request,excluding Sanirdays,
Sundays and legal holidays.
Subd.d. Procedure when data is not accurate or complete. An individual may con[est the accuracy or completEness of public or privace
data conceming himseif. To exercise this rieht,an individual shall no[ify in writin;[he responsible au[hority describing the namre of the disagreement.
The responsibte authority shall within 30 days ei[her: (a)correct the data found ro be inaccurate or incompiete and attempt to nodfy past*ecipients of
inaccurace or incomplete data, including recipients named by the individual; or(b) nodty che individual tha[he believes the data to be correct. Data
in dispute shall be disclosed only if the individual's sta�ement of disaereement is included wich the disclosed data.
The de[erminadon of the responsible auchoriry may be appealed pursuant to the provisions of the admuusuadve procedure act rela[ing to
contesred cases.
DATA PRIVACY ADVISORY
In accordance with M.S. 13.04, Subd. Z, "Rights of subjects of data", we would like to inform you that your request
for a permit or license from che City of Orono or any of its departments may require you to furnish certain pri��ate or
confidential informa[ion.
You a;e notif:ec cha[:
1, The information you furnish will be used to decermine your qualification for the permit or license requested.
?. You may reh:se to supply data, but refusal may require tha[ the City deny the permit or license.
;. The information may be shared with other local, state or federal a�encies to the extent necessary to process
the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
�. You have cercain rights under ti1.S. 13.04 (available upon request) to review private data on yeurself.
6. Your full name is required to process this application or permit.
W��-�-��� G��6�� c��sn�1
First �iiddlz Last
QOgo Gk�S�i�ZG- I�.��G-- -
Address � ,-_ �^�q.
PL`(�mov�'C� (Y1 I�Ncs��4 5��t�Cp C� 2 -5��- -� �
City Stace Zip Phone
I understand my rights as stated above.
��� �, �.����
Signature
i w CHECK OFF LIST FOR ISSUAlvCE OF PER�tiIITS
FOR OFFICE USE ONLY
�DDRESSORLEG:�L: �oib so"'�2s�� �a"'e PID:
DESCRIPTIO\ OF «'OR�i: P�d
ZO`'�i G RE`'��V B�': O ��I��- _ DATE APPROVED: r z-�-y s'
� BY�� DATE APPROVED:
EUII.DL�G REVIE`V
FEES TO BE C�L�RGED: vq�,o ,g�r. Niisc. Fees Calculated By:
PERti1IT YzS � �o
PL:��1 REVIE��I Yes No ✓ SEWER COI�NECTION
STATE SliRCH�RGE Yes No J WATER COi�NECTION
INVESTIG�TION FEE Yes No PARK FEE
SAC Yes No SITE INSPECTION
Number of S�C Unics OTHER (specify)
ZONl�
G CHECK LIST Zoning District:M �R"i3 Shoreland Discrict . Ne
P t School Dis�rict:
Fire Depar[men[: ���jf
Lot Area: Sq.fr.
Acr 7`/ idth Depth
Survey Submitted: Yes �C_ No Date of Survey: �d'zY-4S
Proposed Secbacks:
Front lL�e)� Ri�ht Side:
Rear (Screec): Left Side:
Adjacen[ Structures: Wetland:
Building Height: Def. Hgt. Peak H;t.
Avg. Setbacic:
Bluff Secback: Lot Covenge:
N�P Exiscing Proposed
Hazdcover: 0-75'
75-250'
250-�00'
500-1000'
Hardcover Variance Required: Yes No
Dace of Council Approval:
v roval Date: I L-(-`�S By:d��• Council :�pproval Date:
Gradin�: Staif APP
Septic: Staff �+pproval Date: Nr� BY�
o File: n ?.o�ti Resolution: � Resolution Date: S� �� �
Zoni.n, �
REI�IARK.S (in house):
26
.,_ - i
BtiII.DL1G RE�`IE��' CHEC� LIST
UgC: CO STRUCT'IO 'TYPE:
Fooca�e 5 er Sq Fcs
Basement � —
lst Floor � —
Znd Floor X —
Gara;e � —
X -
OTaL
Es imated Const tion V lue:
Inspectio Required: ork Requirin Se arate Permits:
Site Plumbin Fire
Har cover Removal Ytech � al Water Connectio
Foo ing Septic Sewer Connection
Fr ' g Firep! e Lawn Irrigation
Ins ation (. as ) Other
Wal Board (� f� ) Well (State Permic)
_� Final GradinglFilling Electrical (State Permt
Other
xEtirAxxs (�+ xousE):
REVIEtiV BY OTHERS: DATE:
Access: Ezisting New
Access Approval: Dace BY�
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gE11�ARKS (TO BE NOTED ON PERIVIT1�:
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