HomeMy WebLinkAbout1999-011472 - reside PERMIT
CITY OF ORONO PERMIT TYPE: -
2750 Kelley Parkway- P.O. Box 66 - _ �-='�_��_�
Crystal Bay, Minnesota 55323 Permit Number: _ .. _ _ _ .__
(612) 473-7357 Date Issued: _ - _ .:
SITE ADDRESS: i
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DESCRIPTION:
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FEE SUMMARY:
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CONTRACTOR: -- .,:-<<-1 i E�.�:.±=F. — °=��� . +_�t�: .OWNER:
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APPLICANT P MITEE SIGNATURE UED BY:SIGNATURE
5-2(�-1 �_��_��_� �: I 8AP 1 F�UP 1 T4U I P�,1 C I T'r" Ei::TE�I U�`� Ei 1�' 4�'S 6457 P. I
C.t i T :�l� liKOfYO � G��4t30�'10 U41�419t3 Oc5:59 �' :0'i/U� N0:36�
� �To�1,���: $ oa � o s q
� _ Date Rfi�eived: s.•.Z �
�i=i«d By: Per�it#: � ! �
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CgTY ��' pRfJi�� - �3�,n�N� ��RriII'T APP�.��A,TIQI�I
Ail ls�Yormation must be s�bm�tted !n f�ll before plan review wiiI be started.
(plea.a'e pr�ttt al!ir{fornutlion)
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�i� �'PLi�CA.NT T5: (circXe one} OW'T�*"ER OR �ON'X'22ACTOR
dbB SITE ADY}RESS: � - � � ZIP: � r
�'�,1��', �r+ OWt�i�: L�.L�� ��L1�'iL�L2���� ����': (�'ib1�7lC). �U7-��Ir��
(WOr}f) S��-�-.x? �a�
1���,I.rIG��T�lEZ�5S: � . J�I� CI'I"Y• — Z�--
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��;��'��'X'��q; 7WIN C,ITY �XTERIORS C0. , If��C. p�[(��; (612) 425-4757
C�I�`'�'A��'T�'ERSUN: JQH�J JORUD/CLAUDIA 3V�f���,�Ii't#GE�Z: �V/A
n�T.A�IGAJQIIR�S�: 9GG0 �ACHARY LAAJE N. 1,f10��C�TY: MAP!� ��GVE Z�P:�,536g
ST�,� LIC7E�iSE; � 2 5�5 �'�
A�C��TECTIk�1�iGI1�I�ER,: ��IdN�:
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�d�: R�GIS"�`!tA'Tla:ti# ---
�� OF �'ORK: Ncw Additio�s Accc�sozy Struciur�
Mave �RemodCtlAlierstion�_ Land C�.lt�ration���
PR���SED WORK(dest�ribe in drtain:����1 L�� _. ___
�'��:'`°�S: �,.. �Q.��T OF EACH FLt7t3R:
�a'Q, t�F BEARQQI�'1S: �ARAG� ST�iLLS: ATT. DET.
ES"i'�1'y1ATEI� ��N�'I"RiJCTTClN"VA�.UATION Ccxc3�dl�g Iana): �
Y Yzcr�cby apply for a builditlg penuit and I acknowledge shat thc informatEon above is c�mglete and
accurate; t�c chr work wi]! be in conformancc with tl� ordinances a.�d codcs of thc �iry aa�sl with
thc St;�ic B�z�iditsg Cvd�; ihai I undsrscarul �iis is aot � per�m.tt and w�rh is not to start wlthout a
permic; e,nci that thc wark wili b� in accprd�ncc with Ihc appcovc� plan.
A.P�'i.ICA.trtT'S S��!`IATU�Et,E: � DA�: � [�[,,"��
�'4�':: P.ar�nf gI'ontes tven r�qutr� separut�permtt approval by Pa1�ce Depart�rsenl and
�ity Counc�i GO days pr�vr!p lhe �venl, Non perrrritted evsrsds w�l!not be ctll�wed.
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Sec.13.04 RIGFiTS OF SUBJECTS OF DaTa ' .
Sutd. 1. Type of data. The righcs of individual on whom che data is scoced or ro be starcd shall be u sec forth in this secdon.
Subd.2. In£ormaaoa reqtrired to be given indiridual. An individual uked to suppiy priva�:or coafideariaI daa concerniag himself shall
be infarmed of: (a)the putpose and in[ended use oE the requuted daca wichin the eollecdng Sace ageary,poliacal subd.ivision,or scamwide rystem;
(b)whethe:he tray r.fuse or is.le3ally cequir.d c�supply the rqucss:d dat+:(c}any iatown coasequ:nce arisia3 from his si:pplyiag oc refusing m supply
privac_o�connder.�at dam;ar.d(d)the ideadry of o�her peaoas o�eaddes au�oriz:d by snce ar federai taw to rruive t�e data. This requiremenc shall
not apply when an ir:dividual u asked to supply iavesdganve dan,pursuaac ro secdoa 13.82,subdivision 5,co a law enfo�cemeac officer. .
'I�e eenmissioner of rcvenue mav piace che nodc- r�uir_d under this subdivision in [he individual ir:come t3z or orovem tiz cefund
inscrucdocu irucead of on chose forms.
Subd.3. Access to data by indIvidual. Upon request to a cespatuible authoriry,an individual shatl be informed whechec he u the subject
of stord dan an individuais,aad whether it is etassified u public,private oc eonhdenaal. Upaa his furthe�r_quest,aa individual who is the subjecc
of scor.d privac:ar public daa on individuaIs shall be shown the dac�wichout any eharge to him and;if he desires, shall be infocmed of the eontenc
and meaning of chat daca. Ahe�an individuai his been shown the priva`,dan and iaformed of ies meaaing.the dara ae:d not be disclased to him for
siz mondu chereafur unless a dispau or acaon purSuanc to this secdon is pending or addidonal dara on the individual has been collect�d or ereamd.
Zhe respocuiblt autt:ariry shall pcovide copies of che privaca or public data uFon tequest by[he individual subject of�he daca. The responsible authoriry
may requi:t the reGLesdng person to pay the accual coses o[ma.'cing,cerflfying,ar.d eompiling the copies.
'Ihe responsible auchoriry shail camply imrr:cdiataly,if possibie,wich any requat made pursuant to chis subdivision,or wichin five days of
[he dare of�he requesc,ezciuding Sacurdays,Sundays and legal holidays,if immediace compliance is notpossibte. If he csnnot comply with the requesc
wichin chat ame,he shall so inform che individual,and may have an addidoaal five days withiu which to comply wich the requast,excludiag Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An ir.dividual may concest tht accurncy o�eompleteness of publie or private
dara conceming tiunself. To ezer.ise chis righ�an individual shall nodfy in wriang d�e responsbic auchoriry describing the nacure o[the d'�sagreemeac
The responsible auchoriry shall wirhin 30 days eicher: (a)correcc the da�a faund co be inaccurate or incompiete and aaempc to nodfy pasc recipienc�of
inaccurate or incomp(ece data, including recipi:n�s named by �he individual; or(b)nodfy the individua!thac he believes[he dae to be correcc. Daca
in dispuce shall bo disclosed ocily if the individual's s�ter,.enc of disagteemcn�is includtd with the disclosed data.
'Ihe decerminadon of the responsibta authoriry may be appaaled pursuanc to che provisions of che administrarive proceduro act relaang to
contesad cases. -
DATA PRTVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Ri�hcs 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 depanments may require you to furnish certain private or
confidential information.
You are notified thar.
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 Ciry deny the permit or license.
3. The information may be shazed wich ocher local, sca�e or federal a�encies to the etcent necessary to process
the permit or license.
4. If your requested permit or licease requires Council action to approve, some information may become
public.
5. You have certain ri�hts under M.S. 13.04 (avaitable upon request) to review private data onyourself.
6. Your full name is required to process this applica�ion or permic.
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I underst my ri�hts as stat above. ' �
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