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Sec.13.04 RIGIITS OFSUBJECTS OF'DATA ' ��i ' ;�":,��
Subd. 1. 1`ypc of data- 'C4e rights of individual on whom tho data is scoccd or to bc so�ccd�l�ie�sseZ focd}�fnthis scctioa, 4
� � - . ' � .. ..�JF`.'�. �'L:.�'� :Y >. .,. ,
Slibd.2. Informatioa requlred to be giren indi�idual. An individual ukcd to suPPtY P.�a or confideadal data coaceming himself shall
be info�mcd of: (a)tho puiposc wd intondu!use of the requcsud data within tha collecting state ageucy._poGtial,tubdivisioa.or staLowide rysaem�(b)
whether he may refuse or ic kgally rcquued to svpply the requested data;(c)any tnown coauqueuce uising from his supp[ying or re[usiag to suPP1Y
pcivax or confidenfial data;and(d)the identity o[other persous or eatiaes autbotized by uate or fcdaca!law�o rcceive the data. This requi�mcnt shall
not apply when�n individual is uked oo supply investigative data,pursuant to seetion 13.82,subdivuion 3,to a law enforcemeut officer.
'Ihe commissioner of revenue may�lace the noace Rauiced ander dus mbdivision in the individual income tax or arooertv rez izfund insuvctions
inscead of on those fornu.
�bd.3. Acc�to data b�hdividual. Upon request�t0 a rospoas9ble authodty,�n individw!shall be info�cd whether he is the subject of
soorcd dara on individuals,wd whether it ic classi5ed u public,pcivace or eoafideatial. Upon his further request,an iudividual who is the subjcct of stored
Pciva�or pubtie data on individuals shall be shown tho data without�ny eharge to hlm u�d,if he desins,shall be infonmed of the eoatent and mcaning
of that data. After an iudividual has been shown the privato data aied infotmed of its meaning.1he da�ta nced aot be d'uclosed to him for aiz moaths
dx�ier•unless a dis�{i�or acflon pursuant oo this section'is pending or addiaonal data on the individual has been wAecud or ecuted. The raponsible
auchoriry shal!provido copies of the private or pubGc�data upoa rcquest by the individual subjcct of the data. The respoasible authority may nquiro tdc
rcquesting person to pay the actual costs of maldng�ccrtifyiug,and wmp�7ing the copies.
Tfio`tespo�le wthoriq�shall eomply Immediately,if possible,with any iequest made pursuant oo this subdivuion,or within 6ve days of the
dat�of the request,excluding Sawndays,�ays u�d kgal hotidays,if itu.mcdiate complianee is noc possibie: If he cannot comply with We mquest wichin
thac pme,he shall so info�m�he iadividual,and may have an iddidonal five days wichin wWch ro comply with the request,excluding Saturdays,Sundays
and legal holidays. • .
. � .
� ' �bd.4, Procedwre whea data is not accurate or eompkta An iudhhilual way'contest the iceuracy or wmpleteness of public or private daa
conceming hinuelf. To axerciso t4is right,an individual shall notify in writing.the responsibl4 authoriry descnbing the aahue of the disagreemeaG 'ihe
respoas�le au�hodry shall wi�in 30 days eidxr. (a)eoc�ect the data found to be inaccaracc or iacomplete ind�uempt Do aoaty past recipieua of inaccunce
or incomplere dara;inefuding rceipieacs named by the individual;or(b)notify the individual that he bclieves the daa to be cornct. Data in disputc shall
be disclosed only if tho individual's staecm�nt of disagrccmcat is included with tfie disclosed dara.
'Ihe determination of the responsi'ble autfioriry may be appealed pucsvani Do the provisions of tho adminishative procedure act relating to contestcd
cases.
DA,'�'A PRI�ACY A.DV�SORY
In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request
for a pernut or license from the City of Orono or any of its departments may require you to funaish certain private or
confidential information.
You are notified that:
1. The infocmation you furnish will be used to determine your qualification for the permit or license requested.
2, You ma}� 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 eztent necessary to process
. the per�mit or license. •
4. If your requested permit or license requires Council action to approve, some information may become public.
,; 5. You have.certaim rights under M.S. 13.0� (available upoa request) to review private data on yourself.
6. You full azn is equ' d to process is plication or permit.
� �
Fint ! O� � '�L /Midd}q _/ , ` Last .
�O �o r�f b,�.S/d
Addre��, ,t,<.c.v r �� �i�it/ �5�� "`�1Sd�—" � �-l�00
Ciry State Zip Phone
I underst my rights as tated ve.
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' na e
10
CHECK OFF LIST FOR ISSUAI�TCE OF PERtiIITS
_ FOR OFrICE USE ONL.Y � .
ADDRESS OR LEGAL: l �Z c� F' p�C S
PID:
DE.SCRIP'I70N OF ti'YORK: 11.t rvw�e� Ch�ti.c l�ro�a� -
.
ZO��G REVIE�'Y BY: — D�.TE APPROZ'�D:
BUILDIstiTG REY��BY: D?�TE APPROYED: 2 -�- vr .
FEES TO BE CH.4RGED: tiiisc. Fees Calculated By:
PERMIT Yes ✓� No :�
PLAN REVIE�1 Yes ,/ No SEWER CO��iYECTION
STATE SURCHARGE Yes �/ No WATERCO��I�YEC"ITON
I�,'VESTIGATION FEE Yes No _� PA��E
SAC Yes No f SITEINSPECITON
Number of SAC�Units OTHER (specify)
ZOti'7._1tG C�Cb LIST zonin�Disc�.c:: NU C NA/vG�e .
Fire Department: Post Ofnce: School District: - �
L,ot Area: Sq.fr. Acres W dch Depth
Surve;� Sub�itted: Yes No a[e of Survey:
Propased Setbacks:
Froac (L�ke): Ri�`:S;de:
Rear (Screet): I.e`S'.�'=:
Adjacenc Struccures: �Vetlz� : •
Bu�din� Hei�ht: DeE. H�t. Pea`_: t.
Loc Coverage:
Gradin�: Stafi Approval Date: gy: Council Approval Date:
Septic: Stafc Approval Date: By:
Zoain� FIle: fi Resolution: = Resolution Date: .
Shoreland District:
Av�. Secback: B[�_�Setbac{: LOC CO�`�=e' -
E�:;�; Proposed
Hardcover: 0-7�' -
75-250' �
ti0-500'
Sd0-I000'
Hardcover Vari�ce Required: Yes tio Dace of Cou^cL Aoproval:
gE�IAR�;S (in house):
7
BUII..DING REVIE`V CHECK LIST
UBC: R- 3 - CONSTRUCTTON TYPE: �1v
Sq Footaoe 5 Per Sq Ftg
Sasement x =
lst Ftoor z =
2nd F1oor z =
Gara�e z =
z =
TOTAL
Estimated Coastruction Value: $ -1 �� O 00 �
Inspectioas Required: �Vork Requiring Separate Permits:
Si[e _�Plumbing ' Fire
Hardcover Removal � Mechanical Water Connection
Footin� Septic Sewer Connection
X Framin� Fireplace Lawn Irrigation
—� Insula[ion (Masonry) O[her
�_�Vall Board (Mfg.) Well (State Pemu[)
o� Final Grading/Filling oC Electrical(State Permit)
Other
RE`�IARKS (�i 1 HOUSE): �
REVIEW BY OTHERS: � DATE:
Access: Ezistin� New
Access Approval: Date By:
RE`IA,]RKS (TO BE NOTED ON PERMIT�:
8
Bruce Kienke '
1820 Fox Street ' #585046
Page #2- Conti .
Wayzata, MN 55391-9331
GEOLOGICAL MATERIALS COLOR HARDNESS FROM TO
clay red 150 186
sandy clay red 186 209
clay & gravel grey 209 215
gravel. yellow 215 230
gravel , shale, sandstone
mix white/light blue 230 235
bedrock grey 235 240
bedrock red 240 251
bedrock red & brown 251 254
bedrock red 254 259
bedrock tan & brown 259 271
bedrock red & brown 271 276
bedrock tan & brown � 276 283
sandstone clear 283 285
bedrock tan & brown 285 314
bedrock tan,brown, red 314 327
bedrock red & brown 327 343