HomeMy WebLinkAbout1998-010329 - land alteration PERMIT
4 CI�`Y OF ORONO PERMIT TYPE: � �- �~-�
2750 Kelley Parkway- P.O. Box 66 4=`�'��`� `�`� �;����j
Permit Number: i i i.:;��;��°=�
Crystal Bay, Minnesota 55323 Date Issued: i:7i=.j t�:�,r°=:;:
(612) 473-7357
SITE ADDRESS:
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FEE SUMMARY:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATU �
a PERMIT
•� Cf�Y OF ORONO PERMIT TYPE: _
2750 Kelley Parkway- P.O. Box 66 �.:``�r:!�_L��.?����`�?
Crystal Bay, Minnesota 55323 Permit Number: �_,�s_;:;'�'_�
(612) 473-7357 Date Issued: ia�.:'i_:N�i�`��Ys
SITE ADDRESS: �� Me�.�,llcy
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DESCRIPTION:
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REMARKS:
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FEE SUMMARY:
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PPLIC NT�P ITEE SI NATURE ISSUED BY:SIGNATUR .G,�,
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� Total Fee: $ Date Received:
Entered By: e f� Permit#: ��, ��.Z�;
CITY OF ORONO - BITII�DING PERNIIT A�PPLICATION
A.11 information must be submitted in full before plan review will be started.
(please print all information)
THE APPLICANT IS: (circle one) OWNER OR CONTRACTOR
JOB SIT'E ADDRESS: �Ccr� a�c� V�A/'�2 �c} ZIP:
�� � C-2 L��2 �ci.�� (
NAME OF OWNER: �';�, c�--� Q ��C�✓L-'�� PHONE: (home)
(work)
MAII,ING ADDRESS: CIT'Y: ZIP:
CON'I'RACTOR: �<< ��e Cc�ws 1 ,�-���,m�-- PHO�TE: � �3-- (�3 73
CONTACT PERSON: `— -���w -z (.._-MOBILE/PAGER: � "n – 0 7 y/
MAILI�i tG ADDRESS: /3fX== 1 �� /.� f�i�F7«�CITY: � ZIP: SLcCl/
STATE LICENSE: #
ARCHITF:CT/ENGINEER: PHONE:
MAII�ING A.DDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF `VORK: New Addition Accessory Structure
Move � Remodel/Alteration Land Alteration
PROPOSED'�VO (describe in detai�: ��r�c.F -t��� ��� ��, F--d- Lr1
�ti ��✓ �_.i._�^�- Lo -
STORIES: SQ. FEET OF EACH FI.00R: �
NO. OF BEDROOI�IS: GARAGE STALLS: ATT. DET.
ESTII�i IATED CONSTRUCTION VALUATION (excluding land): $
I hereby apply for a buildin�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 iCity and with
the State Buildin� Code; that I understand this is not a perm.it d work is not to start without a
permit; and that the work will be in accord w' the a r ed plan.
APPLICANT'S SIGNAT'LTRE: � DATE: �'�3 "�
NOTE! Parade o Homes events require separ e pe t approval by Police Deparlment and
City Council 60 days prior to the event. Non permilted events will not be allowed.
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Sec.13.04 RIGHTS OF SUB.TECTS OF DATA
Subd. 1. Type oE data. The righcs of individual o¢whom[he data is stored or to be stored shall be as set focih in this secdon. -
Subd.2. Information reqirired to be given iadividval. An individua!asked W supply private or confidenaal dars conceming himself shall
ba informed of: (a)the purpose and inrended use of the requesr�d dara withia the cotlecdng Sta�e agency,polidca!subdivision,or sratewide rystem;
(b)whaher he tnay refuse or is legally required co supply the requesud da[a;(c)any Imown consequence arising from his supplying or refusing to supply
private or eonfidendal data;ar.d(d)the idendry of o�her persons or enddes au[horized by stace or federa!!aw to receive the daca. 13is requirement s6a11
noc apply when an individual is a;ked to supply invadgarive dam,pursuaat to secdon 13.83,subdivision 5,to a[aw enforcement o�cer. -
The commissioner of revenue mav olace che noace rauired under this subdivision in the individual income rax or�rooertv rdx refund
instrucaons instead of on chose forms.
Subd.3. Access to data by iadividual. lipon requesc to a respansible au�horiry,an individual shall be informed whether he is the subject �
of stored data on individuals,and whecher it is ctassified as public,privace or confidenaal. Upon his fu�ther reQuest,an individual who is the subjecc
of stored private oc public dara on individuals shall be shown che dara wichout any charge to tiim and;if he desires,shall be infocmed of ehe content
and meaning of rhat data. Afrer an individua!has been shown the privace data and informcd of ics meaaing,the data need not be disclosed to hicn for
six manclu chereaicer uniess a dispute or acdon pursuan�to chis secdon is pending or addidonal daca oa the iadividual has been collecud or crca�ed.
The rospoasible authodry s6all pcovide copies of the private or public data upon requese by che individual subjecc of che dara. The responsible authoriry
may cequire rhe requesring person to pay the acnial cosc�of making,cerdfying,and compiling the copies.
The responsible auchoricy shall comply immediately,if possibte,wi�h any request made pursuant to this subdivision,or wi�hin five days of
the date oF che request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request
wirhin[hat dme,he shatl so inform[he individual,and may have an addidoaal five days wi[hin which to comply wi[h the request,excluding Saturdays,
Sundays and legai holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest ehe accuracy or completeness of public orprivate
da[a concerning tiimself. To exereise chis right,an individual shall nodfy in wridng the responsible aurhoriry describing the namre of the disagreemeac.
The responsible au�horiry shall within 30 days ei[her: (a)correct the daca found m be inaccurste or incomplece and attempt co nodfy past recipiea�s of
inaccurate or incomplece daca, inctuding recipien�named by che individual;or(b)aodfy the individual thac he believes rhe data to be coaec� Data
in dispute shall be disclosed only if the individual's sta�ement of disagreement is includad with che disclosed data.
The decerminadon of the responsible auchoriry may be appealed pursuanc to che provisions of the adminisaarive procedure act reladng to
contested cases.
DATA PRIVACY ADVISORY
In accordance wich M.S. 13.04, Subd.2, "Rights of subjects of data", we would like to inform you that your request
for a pemuc or license from the Ciry of Orono or any of iu departments may require you to fumish certain private or
confidential information.
You are notified that:�
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 City deny the permit or license.
3. The information may be shued wich other local, state or federal a�encies to the excent necessary to process
� the permit or license.
4. If your requested permit or license requires Council action to approve, some information may become
public.
5. 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.
First �fiddle Last
Addreu .
Ciry Sam Zip Phone
I understand my rights as stated above.
Signacure