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� STRUCT'URE If11FORfVi,4710tV: <br /> 1.Sfrucfure Dimensions 1.Structure.Dimensions(continued) 2.Type of Construcfiion �'� <br /> a.Lengfh(ft.)= �o�_ Number of bedrooms= 3 �eGv� � <br /> Wood/ rame C?'/t C �� `� <br /> b,Width(ft.)= �7��o�� Number of garage stalls: [] as ry � <br /> Areas in square feet Attached=� , '� e ��u e- ��� l �t�`7 ZD�j/ l�� <br /> ❑P e Bldg. <br /> c.Basement= �g 0 7 Detached= • �� <br /> a.15f story = I�v s <br /> — ❑ n- ite Prefab <br /> e.2"d Story= Off- 'fe Prefab - <br /> f. %Story = Other(please specify): <br /> g.Total Area= 3 � 1 2. <br /> REQUIRED �UBM►TTALS: <br /> Ail of the information must be submitted in order for your application to be processed: <br /> :: ;, .:.... , . . . _ <br /> . ,... <br /> ..:..... :...:. ......:..� ,. . . . <br /> . . <br /> ;. :<Nof€<:>:;;;;;;>;:;;.� � . <br /> ........ .. . <br /> .,:. ... : :;;.,,::.::;;•:<:::,:,<:,:::::;:.::: . <br /> . ,.___. .. : <br /> .Enciosed': =. :;:<s:;:;p.::..licabfe;.<>':`.,: ,. . . ..: ....:::.::::..... .: . _ <br /> :> : •.:•� - ...:. ... . .. . .. . . <br /> P� ❑ PermitA lication <br /> � �( ❑ Pro osed Buildin Pfans <br /> � ❑ MN 5tate Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Pian • <br /> ❑ ❑ Hardcover CalculatiDn s i <br /> L3 ❑ Se tic S stem Sife Evaluafion Re ort <br /> ❑ ❑ Access Permit — � <br /> ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans�for Refainin Walls 4 feef or a6ove <br /> ❑ ❑ Minnehaha Creek Watershed Disfrict Permit s <br /> 1� ❑ Plan Review Fee <br /> ❑ ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICA�lT/OlNRlER ACKNOWLEDGEMENT: � <br /> • Agrees fo provide all information required or requested by the Building Department; <br /> • Agrees to pay the City of Orono for engineering c•onsultanf review cosfs in excess of$500; <br /> • Certifies that the information supplied is frue and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are solely responsible for submifting a complete application�being aware that upon faifure to do so, the staff has no alternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is compJefed and signed; <br /> • Understands some or al!of the information that you are asked to provide on this application is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public but can be given to the subject <br /> of the data. Confidenfial data is information which generally cannot be given to either the pubiic or the subject of the data. Our <br /> purpose and infended use of this information is to annually update our records and records of other governmenfal agencies <br /> required by law. If you refuse to supply the information,the application may not be issued. � <br /> •� Agrees_tFiat:in:fhe;event=ttiaf:weather or:other.;condifions,prevenfi�,flie:cotnpletion;:of:an',as=6uilt�survey:`at tlie;:;time%t(ie <br /> Geifificate;ofi:Occupancy:is:requested;,'a+femporary'Certificate�of.`Occupancy;mayi6e is§uetl�;uponi:receipf�f=a:$1O;Q00 <br /> escrow.to�ensure.co►npletion.:of;ttie:as-Iiuilt survey;and�a►I site improvements: <br /> � ^ � n <br /> � �- <br /> Applicant's Signature: � ��rz-' Date: ��r k� � � , .�v � 7 <br /> a <br /> Owner's Signature: r Date: � <br /> I <br />