HomeMy WebLinkAbout1991-003635 - land alteration . � . _ ERMIT
�.�a�TY OF ORONO PERMIT TYPE:
J t 1:=.r F,_�::}EF 1 i`�E:�?
1335 B�wn Rd. South • P.O. Box 66 Permit Number: i i�j'���:;:�
Crystal ay, Minnesota 55323 Date Issued: `-}�'��'=-��
(612) 473-7357
SITE ADDRESS:
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APPLICANT/PERMITEE SIGNATURE ISSUE SIGNATURE
� '_�
CHEC� OFF LIST FOR ISSIIANCE OF P�PSITS
r^OR OF�'IC� CSE ONLt
ADDRES S OR LEGAI.: I 3�� F R-ENG�l C/��� PID:
DESCR2PTSON OF WORR: r�(, �r•�S o- C���0 �NG
--------------
ZONING R.EVIEW BY: DATE A.PPROVED: �/-1 S-r1�
BIIII,DING REVIEW BY: ��„w•--- DATE APPROVED: L(- (S- q �
FEES TO BE C3ARG�: Misc. Fees Calculated By:
p�IT Yes � No
PLr�N REVIEW Yes No � SEWER CONNECTION
STATE SIIRCHARGE Yes �/ Na WATER CONNECTION
INVESTIGATION FEE Yes No � PARK FEE
SAC Yes No�/ SITL INSPECTION
Number of SAC Units OTHER (speci`y)
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ZONING C3ECR LIST Zoning Dist_ic�:
Fire Department: Pos` Of�ice: Sczool. Dist,~ict:
Lot Area: Width: Dept:�:
Survey Submit ed: Yes No Date o= Surv v:
Pro�osed Setb ks :
� Front ( k i : 3ignt Side:
Rear ( S �eet �e�t Side:
Adjacen Struc sres : et?and:
Building fiei ht: De Hgt. P��k �'��
Avg. Setbac. : Lot overage:
Ex sting Pr posed
Hardcover: -75 '
75 250 '
25a 500 '
500- 000 '
Hardcover Va iance Required: Y s N Dat of Council App val:
Grading: Sta f Approval Date: By: Council Approva Date:
Septic: Staff Approval Date: BY=
Zoning File:n Resolution �: Resolution Date:_
�RMARiC$ (in house) : ;
�- - - .-- - - ---,� � '-_�
BIIILDING RLVIEW �(� LIST
�C: CONSTRIICTION TYPE:
Sa Footage $ Per Sq Ftg
BaseTe_^.t X -
1st Floor X
2nd Floor X -
Garage X _
x
TOTAL
$stimated
Construction Value: $ ���
Inspections Required: Work Requiring Separate Permits:
Site Plumbing Grading/Filling
Mechanical Fire
Footing water Connection
rramina Septic
Insulation Fireplace Sewer Connection
Wall Board (Masonry) Other
r�nal (Mfg. ) Well State Permit
�� :lectrical (State Permit)
�
Otner -----------------
--------------------------
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REMARRS (IN HOQSE) : ��,�� (L��1 N G
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Rh'VIEW BY OTHERS: DATE:
Access : Exis�inQ New
-----Access_Approval---Date------------------�v--------------------------------
RRMARK$ (TO B$ NOT'SD ON PERMIT) :
� ,
CITY OF ORONO - BDILDING PERI�IIT APPLICATION
Total Fee: $ Date Received-
Date Approved:
Entered By:
Permi t#:
ALL INFORMATION MDST BE SUBMITTED IN FIILL BEFORS PLAN REVIEW WILL BE STARTED
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THE APPLZCANT IS: (circle one) OWNER or CONTRACTOR
JOB SITE ADDRESS: I��� �\�--��4-- . ZIP: �j�Z�
(work)�-�ddv�
NAME OF OWNER: ��� '�r�� PHONE: (h ome)��-�1�)
MAILING ADDRESS: �:��C,�i CITY: ZIP:
��� �������
CONTRACTOR: �i�(.>. PHONE: �I � I���
MAILING ADDRESS:�I�� `ti • (��� �� CITY: �. ZIP: �,��-`r�
TYPE OF WORR: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration �
PROPOSED WORR (describe in detail) : �'1�� ��J �Jy � ���—� Vt� �t'',-�I� _
�� -,�Av �r�L -� �.�.�.�,���,
STORIES: SQ. FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRDCTION VALIIATION (excluding land) : $
I hereby apply for a building 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 Fermit and work is not to start without a �ermit; and
that the work will be in accorda c with the approved plan.
APPLICANT'S SIGNATURE: DATE:
lPlease fill out the reverse side of this form)
. � � -
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R����=" -� �ITY of O]E��N�
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�����h� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Officea
,ar..�4 i�.r:,
,��a �.� �=� _w On the North Shore of Lake Minnetonka
DATA__PRIVACY ADVISORY
In accordance with M.S. 15.165, "Rights of subJ ermit o r Iic'ense
would Iike to inform you that your request for a p
from the City of Orono or any of its departments may require you to
furnish certain private or confidential information.
You are notified that:
l. The information you furnish will be used to determine your
qual.ification for the permit or Iicense 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 extent necessary to process the permit or
iicense.
4. If your requested permit or Iicense requires Council action
to approve, some ir.formation may become public.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6, yp�1r full name, and date of birth are required to process
this application or permit.
/�t�' �C.. ��t-R�� �►���,�--� �r �c.
First Midd� Last
Z� v! ��I� �� - - -
Address
- __5 .._ . �i.--- --�--_ _ ----- -------
.-�--- _ — --- - - -
-= - -- - --
Ci y State Zip
��1 - 1'���j -- ----- --- --
Phone
I understand y ights as stated above.
r
S ' ature
BU[LD[NG&ZONING-473•735 i • ADMINISTRATIOIv R.FINANCE-473-7358 • PUBLIC WORKS -473•?359
ASSESSItiG
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C�A�L V 1 N H . H E D L U N D '_ _ .' ;'--� ' `., ' 7�2s Mo�oa� A�.��. so�,n
''' Richfl�ld�Mlnn�soto 55423
Land Surv�yor Civil Enqinser � Phont : 866-2523
, �-
surve � ` '
ar s G'ert� �cate
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����� ��P� JOB N0. ��O-7�
SURVEY FOR� John Laurent
DESCRIBED AS� Lot 8, Block 2 , FRENCH CR.I;EK, City of Orono, Hennepin County ,
I�tinnesota and reservin�; easem�nts of rc�c�rd .
Top of F�uno�olion = 9�p.9 P�o,00sed E/erolions : n --'�'
Gdr�.-� Foa� = �70.5 Exisfin9 E,(�yofion= : t•, ,�, ',�..,�^
Bcrserrienf F/oer • `�6�,E3 Droino9e Dir�c/ions� --►— ' ��','"R�
G�enol�s Tree Lir�e � Denofes L vf Corners : p �'
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TIFICATE OF SURVEY
I hereby certify that on 3 /3! /Bb I surveyed the property described above end that
the above plet is a correct representotion of so(d survey.
Calvin H. Nedlund, Minn. Rey. No. 5942