HomeMy WebLinkAbout1991-003962 - grade ditch/divert PERMIT
CITY OF ORONO PERMIT TYPE: -' L_rE
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1335 Brown Rd. South • P.O. Box 66 Permit Number:
Crystal Bay, Minnesota 55323 Date Issued: `�"f-� =� i
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(612) 473-7357
SITE ADDRESS:
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DESCRIPTION:
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REMARKS:
FEE SUMMARY:
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CONTRACTOR: OWNER: - - Hip.-'
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APPLICANT/PERMiTEE SIGNATURE ISSUED BY SIGNATURE�Lf
CITY OF ORONO - BUILDING PERMIT APPLICATION cI
Total Fee: $„�D.D� Date Received:
Date Approved:
Entered By:
Permit
ALL INFORMATION MUST BE SUBMITTED IN FULL BEFORE PLAN REVIEW WILL BE STARTED
THE APPLICANT IS: (circle one) OWNER r CONTRACTOR
JOB SITE ADDRESS: DO /l✓J�i�f Si ” !//uGL�L� %rZIP:
(work) S^- 3 7
NAME OF OWNER: � PHONE: (home)
MAILING ADDRESS: CITY: ZIP:
CONTRACTOR: TV �C �'�' PHONE:
MAILING ADDRESS: CITY: ZIP:
TYPE OF WORK: New Addition Accessory Structure Move
Demo Remodel/Alteration Renovate Land Alteration__
PROPOSED WORK (describe in detail) : vP.4�JcT�i�
TCI /.uTG % if/.� L 0���-aim /T /��� f/L SGy /-�'UG�T IL
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: s DATE: /
(Please fil out the reverse side of this form)
e�
CITY Of ORONO
Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices.
On the North Shore of Lake Minnetonka
DA _ R� ADVISORY
In accordance with M.S. 15.165, "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 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 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.
5. You have certain rights under M.S. 15.165 to review private
data on yourself.
6. Your full name, and date of birth are required to process
this application or permit.
J0,21AI i�-� ---- - -
First Middle Last
Address
City State Zip
Phone
I understand my rights as stated above.
11
Signa re
BUILDING&ZONING—473-73S7 • ADMINISTRATION&FINANCE—473-7358 • PUBLIC WORKS—473-7359
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