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Home My WebLink About1995-permit application � • y CITY OF ORONO - BOIZDING PERM.IT APPZICATION Total Fee: $ Date Received: Date Approved: Entered By: ' Permit�: AI,I� INFORMATION MDST BE SIIBMITTSD IN FIILL BEFORE PLAN REVIEW WILI' B$ STARTED (See Check-aff List Enclosed) ---------------------------------------------------------- 2'� APPLZCANT IS: (circle one) OWNER or CONTRACTOR JOB SITE ADDR$SS: �.J� �T uI''t �/�� 09� ZIP: (work) .SZ 2-�7// NAI�? OF OWNER- ��'�� G� Y � �-- PHONE: (home) �,3-s��3 1 MAILING ADDRESS: � � � t D CITY: /.� � ZIP: S-��j� ��QNTRACTOR: PHONE: SAILING .ADDRBSS: CITY: ZIP: ,,TATS LICENSE: � /�� r (� �0 . I�IY � !k? �.1 ci c7A�lQ� � ONE�sJ�� .ARCHITECT/ENGINEER. � � MATZING ADDRBSS: CITY: ZIP: ��: RBGISTR�TIOH � TYPE OF WORR: New V Addition Accessory Structure Move Demo Remodel/Alteration Renovate Land Alteration PROPoSED WORK (describe in detail) : `�``��:(� 1 !�� / �� c'_ c� � !� .r�> ;�-�-.. � ),�� ' STORIES:__ SQ- � OF EACH FLOOR: NO. OF B$DROOMS: GARAGS STALLS: ATT. DET. ESTIMATED CONSTRIICTION DALIIATION (eaclnding Iand) : $ ��"�' ' �/�,�s� - � hereby appl.y 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 �nderstand this is not a permit and work is not to start without a permit; and ihat the work wiI 1 be in accordance with the approved plan. � APPI,ICANT'S SIGNATIIRE: DATE: 7�� 9� , �' _ � C ITY of ORONO Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices • � • � � On the North Shore of Lake Minnetonka DATA PRIVACY ADVISORY 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 permit or Iicense from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for �he permit �r �.1CAI'!S@ 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 iocal, state or federal agencies to the extent necessary to process the permit or Iicense. 4. If your requested permit or Iicense requires Counci� action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 to review pri�a�L data on yourself. 6. Your full namP is required to process this application or permit. ��Zl°��'d�1 Q pJ �G'vlG�%J��t First Mi dle Last s3�3 � � �� . Address � �1��/ �-� City State Zip SZZ 7 5 7�/ hone ,�/I �' �3s �T��f2�"� /Ppa� I understand my rights as stated above. - Signatur BUILDING&ZONING-473-7357 • ADMINISTRATION&FIN�+u�ICE-473-7358 • PUBLIC WORKS-473-7359 ASSESSING ��_�_" '_'- _.._. t �. \ r ��pe� RIGH'TS OF SIIB.TP.CTS OF DATA � Subdivision L 'I�pe of date- The rights of lo dividuels on whom the data is stored or to be stcred shall be as set forth in th�s sect An.individuel asked to Subd. 2. Information re9�d to be given indivl�usl. � � su 1 rivate or confidentiel data concerning BmWit�h�in the collecting state ag n Y� PP y P uested da purpose and intended use of the req tem; (b) whether he may refuse or is lega.11y political subdivision, or statewide sys �own consequence arising from his required to supply the requested date; (c) any u 1 in or refusing to supply private or confidential data; and (d) the identity of S PP Y g state or federal law to rice�vest gat ve da a other persons or entiiies autWhen anbndividual is esked to supp y requirement shall not apply pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mg lert tgX re°una lnstructio�insteadhos subdivision in the individu8l income tax or r• on those orms. . --- - . Subd. 3. Access .to �ata by individuaL Upon request to a responsible authority, an individnel shall be informed whe b�c hpr vateeor confidential.e Upon his individusls, and whether it is classified as p � ublic data on e to him and, if he desires, shell further request, an individual who is the subject of stored private or�du� � been individuels shall be shown the date witho of�hat data. After an indi 6e informed of the content end meaning t� �ts need not be �isclosed to shown the private date and informed of its mesning, ��u�t to this section is him for six months thereafter unless a diSPute or action p ending or additional data on the individual h� ate or public datarupon request by � p require the responsible authority shall provide copiesThe respensible aut�rgy maY �in the the individuel subjeet oftrie actual�costs of making, certif n , and comp g requesting person to pay - copies. y if ssible, with any request The responsible authority shall comQly immediatel , P° made pursuant to this subdivision, or within five days of the date of the request, and le holidays, if immediate compliance is not excluding Saturdays, SundaYS � with the ossible. If he cannot comply with the request within that time, he shall so inform the P hsve an sdditional five daYs �+►ithin which to comply individuel, and �Saturdays, Sundays and legal holidays. request, exeluding Subd. 4. Proced�a'e when data is not aceurate or complete. An individugl mgY rivate data concerning himSel�• To contest the accuracy or completeness of public o ln �it� the respensible authority exereise this rig�t+ � ln�� s� notify �ible authority shall within 30 describing the nature of the disagreement. The respo days either: (a) correct the data found to be lete dataeincludingPeec pients namedt bY notify past recipients of inaccurate or incomp the individuel; or (b� notify the individuel t��dusl'�S statementof disagreement s Data in dispute shall be disclosed only if the i • included with the �isclosed data. e�e� p�suant to the ' The determination of the responsible authority may be apP provisions of the administrative procedure act relating to contested cases•