HomeMy WebLinkAbout1997-009467 - replace tree PERMIT
�ITY OF ORONO PERMIT TYPE:
� 2750 Keiley Parkway- P.O. Box 66 Permit Number: -- �` ��'°`.-� .i��v�"�`
Crystal Bay, Minnesota 55323 - - �
(612)473-7357 Date Issued: :
SITE ADDRESS:
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DESCRIPTION:
REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - ":;:��:�3 i �� ; -;� I
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
Total Fee: $ .T' , � 'V Date Received:
' Entered By: ,.:.� Perm.it#: �'yi� i
CITY OF ORONO - BUII..DING PERMIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) �OWNER OR CONTRACTOR
JOB SITE ADDRESS: ���G� /�l < �/�=1 ,''�i , ZIP:
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NAME OF OWNER: ,���'�17f"`�`t l�`�"�� ' PHONE: (home) �;L.
(work) _ .
MAILING ADDRESS: �����"`%'�/. h` /F CITY: ' ZIP: -;
CONTRACTOR: PHONE:
CONTACT PERSON: MOBILE/PAGER:
MAILING ADDRESS: CITY: ZIP:
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME: REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration
PROPOSED WORK(describe in detai�: - � . ✓ � ` - %" ' '
i� , , _ ; . j, ,f�'l/,y'
f� ' _ - , . . i . . . , • . , . � . �
�TORIES: SQ.FEET OF EACH FLOOR: � - �
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (excluding land): $
,a, . �� _ . , . . .
I hereby apply for�a b�g 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.
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APPLICANT'S SIGNATURE: DATE:
NOTE! Parade of Fiomes events require separate permit approval by Police Department and
City Council 60 days prior to the ev nt. Non permitted e ents will ot be allowed.
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Sec.13.04 RIGIiTS OF SLJBJECTS OF DATA
Subd. 1. Type of data. 'Ihe rights of individual on whom rhe data is stored or to be stored shall be as set forth in this secdon.
Subd.2. Information reqirired to be given individual. An individual asked to suppiy privace or confidenrial data concerning himself shall
be informed of: (a)the purpose and intended use of the requested data wirhin the collecting'stare agency,poliacal subdivision, or sratewide system;
(b)whether he may refuse oY is legally requi�d to suppiy the requested data:(c)any known consequence arising from his supplying or refusing to supply
private or confidenaal data;and(d)the idenary of other persons or enaaes authorized by state or federal law to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve dara,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer.
The commissioner of revenue mav place the nodce re4uired under[his subdivision in the individual income tax or Droper[v taz refund
instrucrions instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whecher it is class�ed as public,private or confidenaal. Upon his further request,an individuai who is the subjecc
of stored private or public data on individuals shall be shown the data wichout any charge to him and,�if he desires, shall be informed of the content
and meaning of that data. After an individual has been shown rhe privace data and informed of its meaning,the data need not be disclosed to him for
six month5 thereafter unless a dispute or acdon pursuanc to [his secrion is pending or addiaoaal data on the individual has been collected or creaced.
The responsible authoriry shali provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesting person to pay the ac[ual costs of making, certifying,and compiling the copies.
The responsible authoriry shall comply immediately, if possible,with any requesc made pursuant to this subdivision,or within five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the request
wirhin that time,he shall so inform the individual,and may have an addiaooal five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�'ate
data concerning himself. To exercise this right,an individual shall nodfy in wricing the responsible authoriry describing the nature of the disagreement.
The responsible authoriry shall within 30 days ei[her: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy past recipienu of
inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual that he believes the data to be correc� Data
in dispute shall be disclosed only if the individual's statemenc of disagreement is included wich the disc(osed data.
The determinadon of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act relating to
contested cases.
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a pemut or license from the City of Orono or any of its departments may require you to fumish certain private or
confidential information.
You are no[ified 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 wi[h 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.
5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
6. Your full name is required to process this application or permit.
First Middle Last
Address .
City Stace Zip Phone
I unders my rights as stated above.
Signature