HomeMy WebLinkAbout1996-008391 - grading/berm -- � PERMIT
` CITY OF ORONO PERMIT TYPE:
2750 Kelley Parkway- P.O. Box 66 ��'=;�I�_C�`±=1��iECy
Crystal Bay, Minnesota 55323 Permit Number: ;°,�;;:�;^;�.��
(612) 473-7357 Date Issued: �}_;�;'f;W;r,��,
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRA��;��R: — t��-���1 ic�.7�t. — OWNER:
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APPLICANT%PERMITEE SIGNATURE ISSUED BY:SIGNATURE
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Total Fee: $ ��� � e' � Date Received:
Entered By: �-?� Permit#: 'f.�r �'!
CITY OF ORONO - BUILDING PERMIT 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) OWNER OR CONTRACTOR
JOB SITE ADDRESS: ������av�"���� .br��'�- ZIP: ��.���
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NAME OF OWNER: ��(�1�� � CJ�Si/�O PHONE: (home) � -/ ��
���� �U I_/ � (work)
MAILING ADDRESS: ��cW(�Q.CITY: �%���c� ZIP: ���=
CONTRACTOR: ��� �t.c� � � �✓sT PHONE: C���� ���,-�
CONTACT PERSON: �] MOBILE/PAGER: �7t� ��2-Z�
MAILING ADDRESS: /��� �.����I'•���"� Z. CITY: �(�f�- ZIP: ��C�7�
STATE LICENSE: #
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS: CITY: ZIP:
NAME; REGISTRATION#
TYPE OF WORK: New Addition Accessory Structure
Move Remodel/Alteration Land Alteration 2�
PROPOSED WORK(d�e,s cribe in detai�: l�t ��-�� ��"lv�.�r' -P�yLfiJ�►-C-
%d� C • 4': r��6r— � - �v ��
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: � � DATE: / �'j����
NOTE! Parade of Homes events require separate permit approval by Police Department and
City Council 60 days prior to the event. Non permitted events will not be allowed.
1
Sec.13.04 RIGHTS OF S[TB.TECTS OF DATa
Subd. 1. Type of data. 'Ihe righcc of individual on whom the data is stored or to be scored shall be as set forth in chis secdon.
Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenaal data concerning himself shall
be informed of: (a)the purpose and intended use of the requesied data wi[hin the collecting�tate agency,polidcal subdivision,or statewide sysum;
(b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from lus supplying or refusing W suppty
privace or confidendal data;and(d)the idendry of ocher persons or enddes authorized by state or federal law to receive rhe data. This requirement s6a11
not apply when an individual is asked to suppiy invesdgadve dara,punuanc to secrion 13.82,subdivision 5, to a law enforcement o�cer.
The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income tax or propertv tax refund
instmcdons instead of on those forms.
Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject
of stored data on individuals,and whecher it is classified as public,private or confidendal. Upon his further request,aa individual who is the subject
of stored private or public data on individuals shall be shovm che dara without any charge to him and,�if he desires, shall be informed of the content
and meaning of[hat data. After an individuai has been shown[he private data and informed of its meaning,the data need not be disclosed to him for
six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created.
The responsibie authoriry shalt provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry
may require the requesring person to pay the accual coscs of making,certifying,and compiling the copies.
The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or withitt five days of
the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with the request
within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,
Sundays and legal holidays.
Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or private
data conceming himself. To exereise this right,an individual shali nodfy in writing the responsible authoriry describing the nature of the disagreement.
The responsible authority shall within 30 days eicher: (a)correcc the data found to be inaccurate or incompie[e and attempc to nodfy past recipienu of
inaccurate or incomplece data, including rocipients named by the individual;or(b)nodfy the individual tha[he believes the data to be correcc. 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 authority may be appealed pursuant to the provisions of the administcadve procedure act relating to
contested cases.
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 license from the City of Orono or any of its departments may require you to fumish certain private or
confidential information.
You ue notified that:
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 shared 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.
First Middle Last
Address
Ciry State Zip Phone
I understand my rights as stated ve.
Signature
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