HomeMy WebLinkAbout1999-011978 - land alteration � � PERMIT -
CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway - P.O. Box 66 Permit Number: `�:'_;:�:�;���'r �� --�
Crystal Bay, Minnesota 55323 - - - -
(612) 249-4600 Date Issued: -
SITE ADDRESS:
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DESCRIPTION:
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REMARK�:
FEE SUMMARY:
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APPLICANT�PERMITEE SIGNATURE ISSUED BY:SIGNATUR
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Total Fee: $ �G ' Date Received:
Entered By: �/'1 Permit#: //���
CITY OF ORONO - BUILDING PERNIIT APPLICATION
All information must be submitted in full before plan review will be started.
(please print all information)
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THE APPLICANT IS: (circle one) WNER OR CONTRACTOR
JOB SITE ADDRESS: �� ���' ��'/ �n�.�C�- ZIp. �s s 3 y��
NAME OF OWNER• �A""�s w�� '�' PHONE• (home) �7r- �'i 3 �
� (work)
MAILING ADDRESS: �''`'"^� -?r „`� �"v� CITY• �'j��"'� 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�: /���2��-�� �� �� `L"' ` `�= '��` � "��'
�G;�; ., l v c-v-Gu �,.��i . Jcr�' � ,Ge� �-r-e-ec-c�' ��.t.��r cJiCu�'..4c�'C cr,�c.t'�'�
STORIES: SQ.FEET OF EACH FLOOR:
NO. OF BEDROOMS: GARAGE STALLS: ATT. DET.
ESTIMATED CONSTRUCTION VALUATION (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 permit and work is not to start without a
permit; and that the work will be in accordance with the approved plan.
APPLICANT'S SIGNATURE: �✓"� G✓� DATE: �O � �� `Y r
NOTE! Parade 9f Homes events require separate permit approval by Police Department and
Ciry Council 60 days prior to the event. Non permitted events will not be allowed.
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Sec.13.04 RIGH'TS OF SUBJECTS OF DATA
Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section.
Subd.2. lnformation reqlrired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall
be informed of: (a)the purpose and incended use of the requesred data within the collecting State agency,polidcal subdivision,or stacewide system;
(b)whether he may refuse ot is legaliy required to supply the requested data;(c)any lmown consequence arising from his supplying or refitsing to supply
priva[e or confidendal data;and(d)the idendry of o[her persons or enudes au[horized by state or federai law to receive the data. This requirement shall
not apply when an individual is asked to supply investigadve data,pursuant to secdon 13.82, subdivision 5,to a law enforeemenc o�cer.
The commissioner of re�enue mav place the nodce recluired under this subdivision in the individual income tax or propertv tax refund
instrucdons inscead of on those forms.
Subd.3. Access to data by individuai. Upon request to a responsible aurhoriry,an individual shall be informed whether he is the subject
of stored data on individuais,and whe[her it is class�ed as pubiic,private or confidential. Upon 6is further request,an individual who is the subject
of stored private or public dara on individuals shall be shown the data without any charge to him and,-if he desires, shall be informed of the content
and meaning of[hat data. Afcer an individual has been shown the privau data and informed of ics meaning,the data need not be disclosed to him for
siz months thereafter unless a dispuce or action pursuant to [his secrion is pending or addidonal data on the individual has been collected or created.
The responsible authoriry shall Qrovide copies of the privace or public data upon request by the individual subject of the dara. The responsible authoriry
may require the requesdng person to pay the acrual cosu of making,ceroifying,and compilin8 the copies.
The responsible auchoriry shall compiy immediately, if possible,with any request made pursuant to chis subdivision,or wi[hin five days of
the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc
within that time,he shall so inform the individuai,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and lega(holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private
dara concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreement.
'IT�e responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of
inaccurate or incomplete data, inciuding recipients named by the individual;ar(b)notify ihe individual that he believes the dara to be correct. Data
in dispuce shall be disclosed only if the individual's statement of disagreement is included with the disclosed data.
The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to
contested cases.
DATA PRNACY 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 license from the City of Orono or any of its departments may require you to furnish certain private or
confidential information.
You aze notified thar.
1. The information you fumish 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 shazed with other local, state or federal agencies 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.
g. 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.
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First Middle Lasc
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Address M� ,�5� `'ll �{�(—O (.��
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City State Zip Phone
I understand my rights as stated above.
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