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HomeMy WebLinkAbout#1686 Scanned FileCITY OF ORONO P. o. Box 66 Crystal Bay, MN 55323 473-7357 TO: John Burger 3750 Bayside Road Orono, MN 55356 ZONING FILE 11686 NOTICE OF PLANNING COMMISSION ACTION Date of Notice: 9/23/91 COPIES TO: Jeff Martineau Burnet Realty 315 Lake Street East Wayzata, MN 55391 --------------------------------------------------------------------------- TYPE OF APPLICATION: Sketch Plan DATE OF MEETING: 9/16/91 NOTES AND SPECIAL CONDITIONS: VOTE: No Vote Required The Planning Commission provided the following conceptual direction to applicant for the subdivision of Lots A and B. Applicant was advised that the Planning Commission would not consider a subdivision application based on density credits for sewered property and until sewer is ordered to the property, the Planning Commission advised against filing a formal subdivision application. The Planning Commission did accept the combining of C-1 and c as a building site as long as access is provided outside of the wetland areas located within proposed Lots A, Band C-1. Applicant did advise that owner to immediate west of Parcel C-1 had agreed to provide an access easement to the 2+ acre parcel on the south side of the Luce Line. The Planning Commission concurred that Parcel C with 4.2 acres of dry buildable must be legally connected to C-1 to satisfy density credits for 5 acre rural residential zoning. Staff has confirmed that C-1 is located approximately 700-750' from the shoreline of Lake Minnetonka and is subject to the moratorium ordinance. If applicant proceeds with merely supervision of C-1 pl us C from the remaining homestead parcel, a moratorium variance application must accompany the formal subdivision application. As an aside, it may be advisable prior to any further formalization of plans that Mr. Schirmers be asked to review site C-1 to determine septic capabilities. It should also be noted that the Planning Commission found no problem with granting width variances to the properties both located in the LR-lA and RR-lA zoning districts. Please contact my office if you have any further questions. I will be out of the office commencing Tuesday, September 24th through Thursday, October 3rd. lsv To: Chairman Kelley and Planning Commission Members Mayor Peterson and City Council Ron Moorse, City Administrator /3 From: Jeanne A. Mabusth, Building & Zoning Administrator D~te: September 12, 1991 Subject: #1686 John Burger, 3750 Bayside Road - Sketch Plan Review -No formal action required of Planning Commission Zoning Districts: LR-lA and RR-lA Pertinent Ordinances - 1. Section 10.23, Subdivision 6 required for all lots. Lot A & B Required= 200' Proposed= 183' Variance= 17' or 8.5% (B) -Lot width variance Lot C-1 Required= 300' Proposed= 210' Variance= 90' 2. Section 10.55, Subdivision 8 -No land alterations al lowed within a designated wetland. If access to the northern parcel is via the designated wetland, a variance is required. 3. Section 10.55, Subdivision 15 (A)(3) -All residential properties served by municipal sanitary sewer. A limited density credit may be allowed for the inclusion of flood fringe lands "equal to but not exceeding the amount of adjacent dry land which otherwise qualified for development under this chapter". (i.e. if applicant had a dry buildable contiguous parcel of 1 acre, applicant would only receive credit of 1 acre of the adjacent wetland as density credit.) Lot A Dry contiguous = 1.65 Wet = .38 Lot B Dry contiguous = 1.65 Wet = .83 Proposed Lots A and Bare located within the LR-lA zoning district requiring 2 acres in area. Refer to Exhibit C for zoning boundaries of RR-lA and LR-lA districts. 4. Section 10.03, Subdivision 6 (B) -Combination of separated parcels prohibited. No lot or parcel of land which is divided by a public, private or platted road or road easement which results in any segment thereof being less than the minimum acreage required for that zoning district, Zoning File #1686 September 12, 1991 Page 2 shall be allowed to be combined with any separated parcel of land across the road for purposes of qualifying under the minimum acreage, open space, required yard, setback or sanitary or septic system requirements, nor shall building or density credits be credited or transferred between such parcels under any provisions of this chapter. Each separate parcel must individually conform to the provisions of this chapter in connection with construction of improvements thereon. If Lots C-1 and Care to be considered a single buildable site under the RR-lA 5 acre zone, a variance to this section would be required. A special lot combination agreement would be required of applicant if approved. 5. Section 11. 0 3 -Definition 2 4, lot area, minimum ••••• In rural zones not served by sanitary sewer, each lot must contain a minimum of 2 acres of contiguous dry buildable land exclusive of wetlands, public and private rights-of- way, vehicular or pedestrian easements •••• All rural lots must comply with the City's on-site septic system provisions of the City Code. In urban areas served by sanitary sewer each lot must contain contiguous dry buildable land equal to the minimum areas as prescribed in the zoning chapter of the City Code.... Exclusive of public and private rights-of- way, vehicular or pedestrian easements, surface areas below the Ordinary High Water Mark of surface water wetlands or areas out of flood plain elevation for a specific property and have legal access to the building site without encroachment of a wetland or flood plain area. Please note this last statement is not included within the rural area portion of the definition. It suggests that only in sewered areas was the proposed building site to achieve access without intersecting a wetland or flood plain area. Members may wish to more fully review this section. If an access easement is created via Lots A and B, this easement area must be excluded from minimum lot area of each lot. All access easements must be excluded from minimum lot acreage. 6. Section 11.10, Subdivision 6 -Purpose and requirements of sketch plan review. The sketch plan is an initial presentation of a subdivider's intention and serves as a basis for conceptual discussion between the City and the subdivider providing beneficial savings for the subdivider prior to the filing of formal subdivision application. Zoning File #1686 September 12, 1991 Page 3 List of Exhibits - A - A-1 B - C D E - Application -Location Map Survey of Sketch Plan Area & Zoning Boundary Map Burger's Bayside Plat Staff Sketch of Existing Improvements Lot Line Review of Sketch Plan in Relation to New Please review Exhibit Band c, the 3 lot subdivision proposed by John Burger. The property is located within two zoning districts. The northern portion within the RR-lA, 5 acre rural zone, and the southern portion shown as Lots A and Bare within the LR-lA, 2 acre lakeshore residential zone. Review Exhibit D. Burger's Bayside plat was approved in 1977 based on the original 5 acre rural zoning. The property was rezoned in 1988 to LR-lA. Mr. Burger is currently seeking sewer to the portion of the property located within the LR zone. The current proposal is based on the assumption that sewer will be provided to this property. The portions of the property located in the LR district have been included with the proposed sewer district for the Stubbs Bay area. A feasibility study has been ordered by the City and wi 11 be reviewed by the City Counci 1 at their October 14th meeting. Applicant has asked to be allowed to file a formal subdivision application with preliminary approval being granted subject to the property being served with sewer. The final plat application would not be filed until a sewer improvement project has been ordered. If Planning Commission will agree to consider a preliminary subdivision application that includes density credits for wetlands based on sewer being approved at a later date, applicant may be advised to file a preliminary subdivision application. Per Section 10.55, Subdivision 15 (3), applicant would apply for wetlands credit to meet the 2 acre minimum requirement of the LR- lA zoning district. Regardless of whether the property is served with sewer, the 2 lots will require a lot width variance to the 200 width requirement measured at the rear of the front street setback line at 50'. Please refer to the lot width variances required under Section 10.23, Subdivision 6 (B) noted above. If Lot C-1 is to be the buildable portion of the rural lot, a lot width variance would be required as setback areas will be based on the adjacent Bayside Landing plat, the north lot line being the rear and the southern lot line being the front. The lot measures approximately 210' requiring a 90' width variance. Zoning File #1686 September 12, 1991 Page 4 Review Exhibits A-1 and c, Mr. Burger's property consists of 2 separate parcels, a property to the north side of the Luce Line consisting of 4.22 acres that is currently landlocked. For the past 10 years Mr. Burger has attempted to achieve access to this site via easements from private adjacent property owners or from the City of Orono along southern boundary of Bederwood Park running along the north lot line of the Luce Line Trail. Mr. Burger has been unable to file a lot area variance because he has not been able to acquire legal access. In the current proposal he proposes the combining of the 4.22 rural property with a 2+ acre parcel on the south side of the Luce Line, the Parcel referred to as C-1 meets the minimum 2 acre contiguous requirement for a rural property at 2.16 acres dry. Parcel C-1 may be developed as the rural building site with principal and alternate septic sites. The 4.22 acre parcel to the north side must be legally combined to satisfy the 5 acre density requirement. Mr. Burger has agreed to file a special lot combination recognizing the property as one building site (C + C- l). The total 6.84 acre site would be sold as one unit. The major concern for proposed lot C + C-1 is access to the building envelope on the south side. The C-1 site is restricted by the location of the designated wetland. Review Exhibit C, note with the Bayside Landing plat that the rural 5 acre site achieved access via a private drive that intersected the designated wetland. The subdivision involved the granting of a variance for land alterations involving filling and grading work within the designated wetland. In preliminary discussions with the applicant, staff has strongly urged Mr. Burger to work with the neighbor to the immediate west to achieve access via an existing private drive. The applicant has been advised of the limitations of an application that involves encroachment of a designated wetland when other alternatives for access exist. It should be noted that based on Section 11.03, Definition 24 that vehicular easement areas must be excluded from the lot area of each lot. If the applicant proceeds with the filing of a formal subdivision application that involves encroachment of the wetland, Burger must provide written documentation that all adjacent property owners have refused the granting of an access easement. Staff has also asked the City Attorney to comment on the City's obligation to provide access to a landlocked property. During preliminary discussions with the City Attorney, it appears the City has no obligation to provide access to a landlocked property but that it is really up to the developer or owner to acquire legal access. The City Attorney's office will provide a written opinion on this matter at a later date. Zoning File #1686 September 12, 1991 Page 5 Issues to be Resolved for Applicant 1. If applicant is not allowed to file a final plat application until sewer is ordered for the property, would the Planning Commission consider a preliminary subdivision seeking density credits for sewered property? 2. Irregardless of the issue of sewer, would you grant width variances for proposed Lots A, Band C-1? 3. If special lot combination is recommended, would you prefer the building envelope to be Lot C (north side of the Luce Line) or C-1 (south side)? 4. If applicant provides written documentation that all adjacent property owners deny access to the northern property, would you approve access via the designated wetland to a building site within C-1? lsv 546175 bt'3! 1-, ~ ~ N I;) Ck;) t ~ ~ ~ I I ,; .... .... ............... - ->~ .(' C-/. .?,JJ' !,(c rorAl 0.17!,c. wcr 2-16 ! Ac. /MY ,, I .L 6 . /14 J Ac. ront. /. 33 !,tc:. W('r 5. 'r( :! ,re. 0.f'r' r J",;,-<., .-; --/ "'-'-<-,- ···· Bc9., ----~ t;/1 ~ I I' r.-•,- Vi s.-' V ., .,/ /4J. 0~ .!,V J/ ,--., ..... , '-' I , I I / ·-' ... .,,,. 4.zztAc. C ................... ~ 1-, ~ 't -~ SKETCH PLAN FOR JEFF MARTINEAU OF LOT 1, BLOCK 1, BURGER'S BAYSIDE and LOT 50, AUD. SUB. NO. 203 HENNEPIN COUNTY, MINNESOTA ····---....___ 1 ···---J/·· \ -"'· .,.,-I • ............... ,•. ' / .,-' --. .· /g'l .... ?.-: ~~ .• ,Yq~i,l~y /,32• 'j' ~ J!t,VC> / I ---' I ~I II r::.· ~; ~ 'II ~ II) B 2 :'1'8 f Ac Tor,11.., 0-33 t ,,,fc. WFT I. ,-s-t Ac. /JAY L' A 2.o] !Ac rar,1L c1~3fJ"!ACW(T /.6S:!' ,.,r. hr ~ o,; V. fl) I • z,;"I , I A• ~ /18.50 p.-:-1311 ;46, <JS ~ ~· );; l------~:-:::-::-"'.------:::::,,".r.: -· --l:7~.85" °' 27~ 70 ~ : . ): . ;,, )_;:\ ,/:' ·-·;/ :.'. . ' :, ;-{·,.\/: :; :};)#~;if ·.,._c'•·.~··. '. :./(QFFU~''.V&'"GRONBERG·',INC ;:_;i~ .. ·.. . . •·· G. ,111~11/li,r)i ·.t.··11~.•1.•ii,;,,,.~_. L1111/ S.111·,_,.,,_,;_·,.~.-:· •. 'i. it._,_. r1aii11.1•1. ·.~.·_.~, __ .:_: __ ~.\· . . .., . ' '. ·.. . . '. • . .'1:-t··', . . . . . :; . _41{! T,,n'.,~r,K,k ~\t l lll' ·: ll:h~_ L,1kt• '.:~ ~~ 553~/;:~; . · ·· · ·. i}}il2:-l,J-4141 /, :\;"'-,'.: \:.·_;:-;~'3\ 7'/-J 2. ? Co. /?0,40 /VO. 84 I hereby certify that this survey was prepared by me or under my direct super- vision, and that I am a duly registered Civil Engineer and Land Surveyor under the laws of the State of Minnesota. Mark S. Gronberg Minnesota License Number 12755 ~ ~ ;:) DATE ;V I 3-26"-'Jt· SCALE / ": / CJO ✓ JOB NO . 'JI-32') CITY OF ORONO -SUBDIVISION APPLICATION PROPERTY LOCATION Property Identification Please check one -Property _L__ abstract or Attach legal description to application. fJ- torrens?. APPLICANT Phone (home) '/7c3 .... ~se,1<Ecfl"PT-7H/4NK YOU . M .J .•.•;:·.•i: r ·ru·1; tuii Tii.•i..-; ( , ff.i..,t..."'T'-V IJV\.'.l I\V..&. l.J.U•.l'T Name =''°be Buf2~Gtl, Phone (work) i7,,3-355::J ()8/28/9i Address:37~ D1~(b<5 ~@ City: L)~ Zip: ~~S(e ______________________ : __________________________________________________ _ _ Oljff:fffl (if different than applicant) lr'\i1c Name 5e.f' ..f Heu-+ ;n ea,,LL- 13u..r~+ ~ea.-14 Address: ...:515 t....tL kc $-l . € (attach list if more than one) EXISTING LAND USE Number of Tax Parcels 2. Development Size q .~~ "1-, 5~ ll , Oto Present Use (check) ✓ Phone (home) --------- Phone (work) Y.7 ~~ ~ooo Zip: s s ⇒q I Acres Dry Land Acres Wet Land Acres Total, all parcels Residential; no. of units I Other (specify) ----------- Present Zoning District ___ 7(~•_._{ ____ _ PROPOSAL Division f~r Tax Purposes ✓ Lot Line Rearrangement Only (no new building sites) Subdivision for New Building Sites Number of Building Sites: 1 Proposed Gross Density: Minimum Lot Size: Proposed Use: (check) ✓ Existing Units New Units Total Units Units per _f_l _ Acres Sq Feet Dry Buildable Land Residential Other (specify) ______ _ MINIMUM MATERIAL NECESSARY FOR COMPLETE PRELIMINARY APPLICATION 1. Completed Application Form 2. Preliminary Plat information on Certificate of Survey. 3. Certified Property Owners List of owners within 350' (you must obtain this list from Hennepin County Department of .. Finance A-603 Govt Center 348-3271}. 4. As.an addendum to this application, please attach a separate list of any other persons you wish notified of this application. Certification by Zoning Department that Preliminary Plat Application is complete. Zoning Official's Signature _______________ Date _______ _ -------· -· -----------------------------------------------------------------1. Payment of fees (park fees, filing fee, sewer and water assessments). 2. Signed certificate of survey or mylar copies of formal plat. 3. Title opinion. 4. Easements, Covenants, etc. 5. Developers Agreement and Letter of Credit. Certification by Zoning Department that Final Plat Application is complete. Zoning Official's Signature ______________ Date _______ _ FEES Sketch Plan Review (Class I, II & III) $150.00 Subdivision of a Lot Line Rearrangement 250.00 Preliminary Review (Class I & II Subdivision) 250.00 Preliminary Review (Class III and all non-residential) 300.00 + 20.00/Lot Final Plat Review (Class III) 150.00* *(Plus any legal or engineering charges) The applicant hereby agrees to provide al 1 information required or requested by the Zoning Administrator, City Engineer, City Attorney, Planning Commission and Council necessary to process this application and further agrees to pay all additional fees established by ordinance. ;pplicant's Signaturef l!fo..~~~4'.f::::::::!:'!:!!l.:..b\~==;;_------ Jwner's Signature Date Date ,_, 7 --------- ~pplicant must have all submittals into the City offices 25 days before the ~lanning Commission Meeting. Planning Commission Meetings are held on the t:hird Monday of each month. Applicants must be present at all scheduled review meetings of the Planning Commission and Council. If an applicant is 1nable to attend a scheduled meeting, please make arrangements to have an iuthorized agent attend in your place and to advise the Building & Zoning )ffice of this change prior to the meeting. ~ 5 4 6175 r-------------------- Cti'3t 1-, ~ ,--,,,-.. , L.., I I I ' I .. _,,, .. - ~ 4.ZZ!A C . · ..... ,:,,: . ' N ~ ~ t ~ ~ ~ ' I ~~, C -1 ;_1, 33 ! ,.(( 7rH ~l.. 0.1 7 :t •" w € t 2. 16 ! Ac. t)l<Y ,,, I .1 (;. J4 f Ac TO-r/L /. "33 ±-fc w,r S. 'f( ! AC. ORY r J4-""'"" ,,., C ~, --~ ~ 1-, ~ "':- ·~~ ---/ .,,,..,,,. -------~ SKETCH PLAN ' FOR JEFF MARTINEAU I;' ty' ~-4,,' [:_--:- ti ,t /1-J. 05" t;!I I I ~Ill ~-~' ~ II) \I-"' I t. V .\Y ~ OF LOT 1, BLOCK 1, BURGER'S BAYSIDE c1nd LOT 50 , AUD . SOB ·. NO. 203 HENNEPIN COUNTY, MINNESOTA ,-•-~ ,,--, ... _J / / ..... ·i,,:. ---5 /2'1 q~//f'y / 2-0 Ll,<✓f' / /J ------> B 2 ;1'i/ f Ac TOTltl. 0-J3 !. AC. WFT I . c s! Ac. /J ~i A z. o 3 ! AC ror-i L c1.J8 "! Ac W(T /~ 6S-:!' ,r: ~,( r ~ o.; ~ fl) ~I N8.50 ti ~ I -/7~.8S -------~z;":,?'.D,;:,-_-:7:-o~-------,-'-Co. I? 0,4 o ///o. 84 ~- ( \ ~- ,_.} \/:~-:' :/. ;.\~,;_./f-: ·.W~0:f,.~~~::>.Ji°:Jri.\J~,:, ::'}~~-/'. :\: ~ -,,.;;;;;;;;.~ l: ComN · &{ GRONBERG ' INC;•;i? il ~-c.,,i,i,lti11g E11gi11t•fr,. umd Sw,\ifi,,.,. S11c · rtm /,i;;,?t1r.; I hereby certify that this survey was prepared by me or under my direct super-_ vision, and that I am a duly registered Civil Engineer and Land Surveyor under the law s of th e State of Minnesota. · :-s · -.:~~~,. .-· ""' .... '~'( .. -~ · J,, ·e ...... ~ .. ., .. · · .,~'-4~ ·. ( '~ . -{' ·4i\2 fani,1r;ick 'A,·i.•nul' .• Lllllg;L1kl'; MN 5535o •:;;~/ ~ ~tt. : ~--. ,~,, · ~: ,/,:. . -_ ; . ., ..-r · ... · · · c:;,v-· 1 ·?. --: ~-.,. -~:. ~~, · · Tl,~ <"''· .:'--.. , .. •.:.-. ,-..,_y:~ .. i\;!:'.:.-012 ,,1;3 .. u -1 1rff" :,;¥-r~i'*H.l:: ;.::~it:j}:i;=~ ;: :\:-:.~~~~\J_;;;i\tJi;g;trii.i~~!ik}tt~~i .. ,•·· Mark S. Gronberg Minnesota -License Number 12755 ,. ;V I DATE 8-Z6'-?1 SCALE / ''= /()0 / JOB NO. ?l-32? ~--. Pl~: t a:E' =u.·:-... -eJ- fo :."' L! Q ~1n I:-i.1r re r in t!1c r;orth\..'est. l 11"Y o:f ~ect.:ion :,-117-:'.J D J: hc~c-~b:,. .. ("'"er:.i:-':,-t=12t ttis is a true ~inC. ccrrcct. 7s;..,.:-e:ser:0~.- t:0L er-£! s~.:.~ve·· of t!1e batL"1ci~ries 8:~ .J~t 51, .. :.".l=.it.c~'L :.1ut- C.i .. }i~-~:.cr;. ::tz:~ce~ ~\./:, ~er.:..r1c;Jin Ccl..L.i."'1t:.-, l:inneso~, ~/--:e loe~?- tio:: vf ttll e:d.stinc ·oL.ilC.:ir1~~s t~1erecr., :.1.; .. :.... :.::.t: ;..;re- 5 0 Acre.s bv1 /dQb!e 51 7)"··. .. • 1 •• [1U.=._..L,:...:2., • ~ l: ,-. ..,~., .-< __ ,.,' 1~5' , .. · ? ' ..j> 0-,, <, ~--· 146'.5' 150'. ...... 5.i· ShLd• ·._. c-· .. ~ ..-0 );; --__ .,._ ----------'---66.-6,£-5.J.'----c,______ ----------~-!?--.-.·. - ./~ / ---- / [',_,7/._r/,,/;L o/ Cot_,;7-ry /?oad ;vo 84 Os ,rravL./ICO' i ~lf!,~ ~--..r .. :.i ,~U.J'"'.r'-:· ,·c,; : .. r .. c: fl ._,_:-.. ~Y;~::- .:...sCnr .....,,:_,__.:,:(;, ;,ir1nc:s'.JU .-I [ -+-·__, --- + ~, I jl!-=====-I =-----= APPROVED t,.S SUBMITTED ~r...----~1'11 APPROVED WITH CORRECTIONS AS NOTED NOT APPROVED -CORRECT & RESUBMIT These comments are tor your information. All work shall be i-1-:-ne in full compliance with all applicable building &. zoning code re· quirements including items not specifically noted in th'-~-,ev,-JW, KEEP T\-11S PLAN SET ON SITE AT AL'.. T\MES. ---- No·os·4z··£ --349.68-- 66 n 0 C z I '. -f 9Z86. ~ ~-9~ I a) 0 213' -------' ~ fo" .-----. !IZ83• '-<:,._':132.0 --658.02 _ No 0 11·2.s"£ I , I : _.._ !•,I~•• '••· -•'.: -: :.1 . r.... 0, ~I ·:::,/ ~, 386.00 Noo15·44"E, I hereby c .. , \ oun ar,ec.: Lot 1 , u ,'lnd correct r f e.t1•y th<Jt rh·1L ,·s o the b d • - 0 3 tr e ion o a11 b - 1 • ~ SIDE H -a survey An d o f t h e 1 o c a t . f ' B 1 o d 1 ' B U R G ;::-R B A y e r r e c, l' n t ,1 t i o n n f • '; any con . Y, the econ 'nncsot encroachments . f u1 d1nns, if un • cnncpin County, M. the stakes as sc· fa. oc on ,a,d land. It I , and all v;sblc J • · -'l · •, sucveved ,on of o f A u ':l u s t 1 9 7 7 l r a p r o p o s c d h u i 1 d i n . A a s o s. h o \-1 s t h c 1 o c a t . 17--. ( :~b..¥ rnc this 2ft h day 1 I It,~ 'L ,}_ _!__, . -1- Tn3m£ss~ Be7 • b -:"'~'-/ . 0 0 I I 16.50 t.Jo·w 25··£ OENOT£5 DENOTES WOOD IRON $TAKES MONUMENT 13-- ,;:':'::.,•.~·::. .., , •.. ••·· "'""'" Land Su c ve yo c q q ~'.st ..:.PPl<...i .. 1;...., --" "'""'"';;; •·""''" "", •• • ~: • "• .,, " • , n n . Reg N 7 7, L~ 5 '''"'·''"'A ,,•.:,,a T•<l I Ai'$ ·' "l',,,,,a ~ . 0. ' ('F 1...,f ,,.Ar~::,.;. l :cYcJJ! "":··"· "''"''". "'~,,~~,\',OCIATES l'lC. ~"'' /": 100· PREPARED FOR ~-•>-))"'\"\-\.: 'cCOMBS-KNUTSO -.•,,o.:.<-, .... _.., . ._ ~■SIT£ PtAJr'lltU•::O • '•' J, ~ ,~" •.• •••,I I~- 3739 JOHN BURGER Post Office Box 66•Ci-ystal Bay, Minnesota 55323•Municipal Offices On the North Shore of Lake Minnetonka DATA PRIVACY ADVISORY In accordance with M. S. 15 .16 5, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its deoartments mav require you to furnish certain private or confidential info~m- ation. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the ex~ent necessary to process the permit or lice~se. 4. If your requested permit or license requires Council action to approve, some infor~ation may become public. 5. You have certian rights under M.S. 1s:16S to review private data on yourself. 6. Your full name, and date of birth are required to process this application or permit. ~tA 37~ Address Date of birth (does not apply to building/general permits) Phone I un BUILDING "'-"'-'-''" ASSESSING as stated above. ADMINISTRATION & FINANCE -473-7358 • PUBLIC WORKS -473-7359