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STRUCTURE tNFORMAT101V: • � , <br /> 1,Structure Dlmenslons i.3tructure D[menstons(conti�uad) 2.Type of Constructlan <br /> a.Length{fi.)= Number of bedrooms d []�y��/Frame <br /> b.Width(tt.� Number of garage stalis: ❑Masonry <br /> ❑Metal <br /> Areas�aq�t Attached- ❑Pofs 91c�. <br /> c.Basement= Detached= ❑ICF <br /> d.1"�Stary � ❑On-sHe Prefab <br /> e.2nd Story= ❑Otf-site Prefab <br /> f. 'h Story = ❑Other(�lease specSfy): <br /> g.Tofai Area= <br /> REQUIRED SUBMITTALS: . <br /> All of the informafbn►nust be submiitad in order for your applica#ion to be rocessed: � <br /> Not <br /> Enc{osed Ilcable <br /> ❑ Bulldln Permff Escrow reement and Fees <br /> � ❑ Plan Review Fae <br /> 0 Corn leied licatfon Fortn <br /> 0 Pro osed 8uildi Plans-2 fu11 size sets,to scaie and 1 reduced 11 x 17 or 8 h x 11 set <br /> - ❑ ❑ M�nnesot�State Ener Code.Calculetions and Mechanical Code Re uirements <br /> p�,� p Su -2 fuli size,#o scale meetin Al.L surve � uirements <br /> q p Hardcover Cslailatlons <br /> p Se tic S stem Csr�ftcaUon � <br /> O Minnehaha Creek Watershecf Ulstrid(MCWD)Pemilt or � <br /> Documentation form MCWD staSin no rmit ts r utred <br /> p Lendsca e WaAs and/or Retainin WeU Plans <br /> p Stormwater Pollutlon PrevenUon Plari SWPPP <br /> p p Acxeas PermH <br /> p ❑ bata Prlva Adviso Forrn <br /> APP�.ICANT/QW1dER ACKNOWLEpG�MENF: <br /> • Agrees to provide a11 in�ormation requited ar►equested by the BuNding Dapartmen� <br /> . Agrees to pay the Clty of Orono tor engtnsering consul#ant review costs fn excess of$500; <br /> . Certit�es that the Intom�tlon supplled is tnre and correct fo the best of htslti�knowledge. The appitcant recogntzes U�at ttiey . <br /> are solely responsib�e for submftting a cor►�fete applEcabon being aware that upon failure to do so,the staff has no�temative <br /> but to reJect it aM11 it ts complete; <br /> . Acknowledges ihe Eacrow,4Areamenf is c�omptetec!a�stgned, <br /> . Understands some or all of the information that yau are asked!o provlde on this�pilcatlon is dassifled by State law as elther <br /> privafe or oonAdentlaL Privete data ls informaiion which generally cannot be gh►en to the pubttc but can be given fo the�bJect <br /> of the daia. ConQdential data(s lnformatton which generaily cannot be glven to elit►er the pubAc or the subjec�af the data. Our <br /> purpose and Intended use af this information is to annually update our records and re�rds of other govemmentai agencies <br /> requlred by taw. If you refuse to suppty tl�e information,the applir.atfon may aot be issued. . <br /> ...;..•.. ,,:..:�.... . ...:�..:.... .:........ ,..:.:.:..,,..;:�:.�... • r__.. <br /> .,_._ . . ..._. ,...... <br /> . Agre��,:1h�t�n thQ:eWant.tli�twe���.r;�F:�4�@r;�n��,t���$:i�X@�..�It:1h�;'�;:.R��IO�iqn;Pf an:�ls..-puUt.,su�!!�y:et.th,e,�ifiti4;�tfe <br /> CBiiiti,g�e�f.O�GW1etn�Y.l8..�94�t�4l�:�A e�%pdrnrY..Cel'.t��cpfs..of.Occlu�>a�!cy.,may be Issuec�upon�receipt�of a�10��60 <br /> esc�ow to ensure completlon�af the�s-bu�t-survey and�alf�site improvaments. <br /> � • <br /> AppAcant's Signature: �� � Date: ��l��j <br /> Owner's Signature: <br /> ({ar i�en �r+ Date: `� ' l - LS <br /> Packet Last Updated Januery 20f S p��2i <br />