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STRUCTURE INFORMATION; <br /> , . <br /> 1,Structure Dimensions 1.Structure Dimensions{continued) 2.Type of Construction <br /> ii <br /> -7 .711 <br /> a.Length(ft.)= ) f., "..La Numb 04 bedrooms <br /> 51 Wood r i ratrie <br /> 0 <br /> h Width it Number-...5 /2 Number of garage stalls: 11 Masonry <br /> Li Metal <br /> Areas in SOLitae OM Attached _ <br /> 0 Pole fling <br /> c Baserrient= Detached= <br /> 0 ICF <br /> d. 1° <br /> Story .t° El On site Proti,iti <br /> e.2"1 Story,' 0 On-site Prefab <br /> F. 'A Story , <br /> LI Other(ptease specify) . <br /> I g Total Anew, <br /> 1 I <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application lo be processed: <br /> Hot i <br /> Enclosed Applicable I <br /> 0 0 Buylding Permit Escrow Agreement and Fees <br /> . ,...... , .,.. <br /> 0 <br /> 0 Plan Review f ee <br /> • 11- <br /> _. <br /> O (1 Completed Aggffeation Form <br /> O f 0 ProposedBuilding Plans—2 full size sets,to scale and 1 reduced 11 x I/or ft : ii 11 .5ut <br /> • 0 Minnesota State Energy Code Calculations and Mechanical Codf! NtKpiti;rntirttit; <br /> -- _ <br /> O Li Survey—2 full size.to scale(meeting ALL.survey requirements) <br /> 0 11 Hatucove.. Calculations <br /> ---- <br /> 0 171 Septic Srdien Certification <br /> O 11 Minnehaha Creek Watershed District l MCWD1 Permit or <br /> Docurrientatioe from MCWD stating no permit is iiiquiied <br /> 0 LI Landscape Walls andlor Retaining Wail MOM,. <br /> • <br /> 0 0Stormwater Pollution Prevention Plan tSWPPP) <br /> 0 <br /> 0 . .. , <br /> Access Permit <br /> O . <br /> [1 Data Privacy Advisory Form <br /> APPLICANT/OWNER ACKNOWLEDGEMENT; <br /> . • Agrees to provide all information risioiro.1 or requested by the Hundirio Department: <br /> • Agrees to pay the City of Orono for engineering consultant review coats in excess of$500, <br /> • Certifies that the information supplied IN true and correct to the best or healer knowledge The applicant recogranirs Inas trey are <br /> solely rescionsible tor submitting a complete applkation being aware that upon tamer,in do so the staff has no arterrinlive hot to <br /> reject it until Ills complete, <br /> • Acknowledges the Escrow Agreement is completed and vgneld: <br /> • Understands some or all of the information that you aro asked to provide on this applioution is classified in" State law .rs oilnei <br /> private or confidential Private data is informality)vinich govirally cannot be given to the public but can be oven to the whirr lit <br /> the data. Corifidential data is information which generally cannot he given to either the public or the subject of the data Our <br /> purpose and intended use of this information is to annually updalrr our records and records crt" oltier piriernmontal agenoes ; <br /> required by taw If you refuse lo supply the information,the application may nol ho issued. <br /> • Aar***that in the event that weather or other conditions prevent the conviction of an as-built survey at the time the <br /> 1. Certificate of Occupancy is requested,a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> I escrow to ensure completion of the as-built survey and ail site improvements. <br /> ..... ... <br /> Applicant's*nature. e-..-‘-'s"-- d• 0 <br /> .77 <br /> !".."---...—S. Date /D .7-7 .5— <br /> , <br /> Owner's Signature. ‘,.........._ • I... :5 Date: /e° -2- 7 /5._ <br /> peck,,Last Lipuired August 2015 <br /> Paci..?2 <br /> ..........._. <br />