HomeMy WebLinkAbout1995-007623 - pond excavation �
P�RMIT
GITY�F ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 _
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: ;, _,; ; ;� OWNER:
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APPLICANT PERMITEE SIGNATURE ISSUED BY:SIGNATUFi
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� Total�Fee: S ' �� � `' DateReceived:J2 -��� �S'
Date Approved:
Entered By: Permit�: "� � - '�
CITY OF ORONO - BUII�DI�i tG PERI�IIT APPLICATION
ALL INF'OR�I�TION�IUST BE SLB�ffTTED L�T F'ULL BEFORE PL��t REVIEW`VII�L
BE STARTED
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THE �PPLIC:�:�1T IS: (circle one) O`VNER OR CONTRACTOR
JOB SITE �DDRESS: ` 3�`� ��l E�L°� �N��- ��. zrn: ��S`��I
�g ���-t,Y� PHONE: (home)� � '� �� v
NAivTE OF OWNER:�/�KfNf"1' ��f� fl `
� (work)
MAII.ING ADDRESS: � T�l ��"`� CJ��t'�,�(`- CITY: Cy'i�%r�i� ZIP:��3`'i �
CONTRACTOR: �DL�-L'�..�-�r��l �t'� �-1���<S PHONE: ��'�'���l I
��IpBILE PH0�1E/PAGER:
VIAILINGADDRESS: �1� I �o�-'��"' �,��y� CITY: C�!•C���1�9'��" ZIP:�3� �
STATE LICENSE: # �'�(�(� �'� �
ARC�II'ITECT/ENGliYEER: J�y�� PHONE:
MAII,INGADDRESS: CITY: Z��
���,�_ REGISTRATION #
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration I.and Alterarion�
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PROPOSED WORK(describe indetail): ��(c' �i:��`" �. �•'���� �'L-i�-,�,�c��:� SZ�f�--5 �� �/j'Z'
STORIES• — SQ. FEET OF E�CH FLOOR: _ —
NO. OF BEDROO�IS: — GAR�GE STAI,LS: ATT. DET.
EST�IATED CONSTRUCTIONV�iI.L;ATION(eY�ludingland): � C,v���•�'Z'
I hereby apply for a buildin� permit and I acl:nowled�e 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; thac I understand this is not a perrnit and work is not to start
without a permit; and that the work will be in accordance with the approved plan.
APPL
IC:�NT'S SIGNATURE:,���.��� 2��� DATE: ! 2 ���b� �i 5�
17� �� /� 5�z,f�K✓J�,'t:
NOTE! Parade o Homes events require sepn rae P�di eQent�willbnot�becal�wed. ent and
City Council 60 days prior to the event. lv p
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Posc of�ce soX 66
�`�,� ,`.,��, l �.� G'� Cn�stal Bay,>linnesota 553'�-006G
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DATA PRIVACY ��DV�.SORY
In accordance «�ith �1.5. 13.0=�. Subd. �, "Ri�hts of suojects or data", we would like to
inform ��ou that your request ror a p�cm.it or license irom the Cicy oi Orono or any oi its
departments may require �-ou co i�arnisn cenain pri��a�e or contidential in:ormacion.
You are notified that:
1. The infonnacion you ruriish �vill be used to determine ��our qualittcation for the
permit or licensz requested.
?. You may refuse to suppl}� da�a, but refusal may require that the Ciry der.y the
pernit ar licease.
3. The information may be snared with other local, state or federal aQencies to the
exter.t n�cessar}� to pro��ss «l� Perm�t or license.
4, If ��our requested permic or license requires Council action to approve, some
information mav bec�me aublic.
�. You ha��� ce,�ain ri�hts und�: �•S• 13.0^ (see fo!lo���in, paQ=) to review private
data on ��ourself.
6. Your full name is required to process this application or permit.
rLEasE Px��r
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';��.ti, ,�� �,r'� �����i�i0�'�--�
First ��1idd:e Last
-��C� I �,� f� �c�,J��-
�ddress
�,�i�r�+ ���v�` ��rv' `�5 3� � 3 6 �"�-�� /
Clry
State Zip Phone
I understand m}� riQhts as sta�ed above.
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Sianature
6
� TEL.EPHO?YE-�3'T�'7357• E�.X-�iT3-O510
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�.04 RIGHTS OF SIIBJECTS OF DATA
Subdivision L Type of da�- The rights of individusls on whom the data is
stored or to be stored shell be 8s set forth in this section. An.individuel asked to
Subd. 2. Information required
to be given in�vi�uel.
1 rivate or confioentiel data concernin a�gTnWi�in the collecti g state gency,
supp y P
purpose and intended use of the req tem;d (b) whether he ma� refuse or lfromhlis
political subdivision, or statewide sys ��� gny �own consequence arising
required to supply the requested dat�;
su 1 ing or refusing to supply private or coorldederellaw to receive the data.1tThis.
PP Y state
other persons or entities autWhen anbndividual is asked to supply investigative data,
requirement shall not apply to a law enforcement officer.
pursuant to section 13.82, subdivision �,
The commissioner of revenue ma lace the notice re uired under this
subdivision in the individual income tax or DroDertV tax re und instructions instead o
on those orms. � - - .
tQ �� by ����. Upon request to a responsible
Subd. 3. Access
authorit , an individu8l shall be informed whetbh�C hP �g�eor confident al.e Upon his
y ublic data on
individuaLs, and whether it is classified as p �
further request, an individual who is the subject of se to�mrl�v�aae if he desires, shall
individuels shall be shown the date witho of�hat da a• After an individual has been
�e informed of the content and meaning the data need not be c�isclosed ta
shown the private data and informed of its mea�i�+ ��uant to this section is
him for six months thereafter unless a dispute or actian P dgta u n request by
ndin or additional data on the individual hes a eeeor p ll�lic ed or �ested. The
� Pe g rovide copies of the p
responsible authority shall p y reouire the
the individual subject of te g���'�o ts of making,l�Qrt fYing, and compiling the
requesting person to pay th _
copies. y ssible, with any request
The responsible authority shall comQly immediatel , if po
made pursuant to this subdivision, or within five day
s of the date of the request,
excludin Saturdays, Sundays and legal holid�a�ni�hat tim ghe shall so nform the
g with the request with the
possible. If he cannot cflmply ,� Within which to comply
individual, and maY �Ve � gdditional five da}
and le al holidays-
request, excluding Saturdays, Sundays g
Subd. 4. Proced�e '�hen data is not accura
te or complete. An individual may
ontest the accuracy or completeness of public or private dat�heo=eSPonslb e au hor ty
� ht an individuel shall notify in writing Within 30
exercise this rig � nsible authority shall
describing the nature of the disagceement. The respo
da either: (a? correct the data found to be in�e a�8e���ng Pee�ipi��namedt by
�
notify past recipients of inaccurate or incomple �
the individuel; or (b) notify the individual that he believes the data t° bQementcis
Data in dispute shall be disclosed only if the individual's statement of �a� t t� the
• included with the disclosed data• ealed pursuan
' The determination of the responsible authority may be aPP
provisions of the administrative procedure act relating to contested cases.
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:XI5TIN6 � �">''� � :��'�i y�,i�;�i;.".;"�.`,.400 5F,,� IMPROVE DEFINITION OF DRAINAGE
:REEK BED...-- _ _r;' -� ,13,2„ x:�.,,;"����.;",�;r;`,,r�,�`^;;, PA7TERN,INSTALL FABRIC AND
:�.'��' i ''`�Y y��;'� 3"-6"ROGK MULCH...
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oFsivNen Fa:�.
E'C��(:WOI'�C �UI�(_�el'S. �[1C. 5arah and Richard Goullard �� mis plan 51� I remaln the pro ertyof
�� ORTI-I�� Edgework E idere Inc.(EB.I.� Any
� <<'K�'>�� � reproduatc or u�e of thi5 plan without.
�� 139 Chevy ChaSe Drive Wayzata,MIJ 55391 � �i', E.B.I.wri� pennission will noC be allc,ved.
� � Unauthon�- �,use 5hall entit-le C B.I,to r.�ll
O �.� I'
�� .,� ��E"' ""�' ��� damages c..yed by such u5er including
_l _ 476-6572 � preparation ind attorney5 fees.
"Mastcrs ol Qualiry consiniction'
D�Tk� DESI NE✓'.
8301 AUf)UBON ROAD•CHANIIASSGN,M1I�V 55J17 SCALE
Nn�,��r:�eiz�3ea-�sii F�x:�aiz,��,x-ssso 8/17/93 revised... Dave 5tockdale 1°-2U'