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APPLICANTIOWNER ACKNOWLE�GEMEh1T: <br /> �•{„r n,,,� _- _.___._.. <br /> . A,1pl:r.:3^,!i��ees�c��r o����e �I+ �ror��ec�;ired ot requested by the Pi�annonq C1eC�artrxi�nt, _� <br /> * Owner agrees to pay the City of Orono fnr englneering consuttant review costs whQre a�plicak�le; <br /> i • Apphcant certitie5 fFa�t the iniormation su�pl�ed �s Ir��e and corr��C;f Ec� kh�I.a�st�f hNs!hEr knnwiedae The applicant <br /> �ecogniZes th3l Ihey are salely responsitale fqr subm�ttirira;�c�m�7l,;tc appi�cat�on bemr.} aware tha! i�pon I,jilure; to <br /> co so the stafi has nt�<�Itern�tiv�biil lo r�ject it unlii ii�s comp,ete; <br /> + Appl+cant acknowledges Ihe attached Escrow Agr�ern�i;t is com�lete<i and s�gned by Owner ' <br /> • Some ar all of the intnrniatinn Ihat you �re askec lo prov�dc:on this�pplir,al+on is classlfierl by State taw as erther <br /> � �rivai�e or confrdantiai Pnvate dat�is ii�fofmal�c�n uvhicl��eri�r�lly��ann��t be yiven to the f�ublic:but can be g�ven lo ; <br /> the suh�ec!af ihe data GOnfidcrnti�l d�t�x i5 inforrnatinn whir,h generaily canncai be given to either th��public or the <br /> sub�ect oi the ciata �}iar�urpqse antl intentlF+d use of th�s inforrr��laon rs!v anriu�rlly tapclate our records and rec�rds <br /> � of other governmenlal apencies requir�ad hy i��iv�r E(yoi.i ref�.�sc�to snpply thc�infonnation: !he applical�on�rray not be � <br /> issued <br /> 7���:undt;rs�ry.ned rertdy Ihat tt7e in/ormatinn supplled�s true and cc>rrert to Ciie best of tfieu knowledge <br /> " � "1 ' , <br /> Applicant`s 5ignature: _� �, � � ',r�'�.n�,��` Uate /� ( 3 �i, <br /> � � �����-- <br /> Prppr.rty C7WnP_r'S Spqnatu�e� - �� -- � f�f _ Clt�te �� r`���� <br /> ' TYPE QF PERMIT: �UBMISSION F2EQUIREMENTS; Excepl fiar irYe r�muv;:3l F�errnr,;, ali permits <br /> , -- require a completed aF>plicatiorr form,escrow agreement(signed by the property <br /> I r�wner) antf ascrow ctreck from owner, twc�copies o1�II plans, and three copies <br /> o(ait grading plans or surveys/site plens <br /> .. — . . _._ __ ..,, __........_.__. <br /> _ _ ___ _ <br /> Oock,Residential tif .�,�,a��;��pp�k-survcy showmt�proposetl dock <br /> ' Permanent bock-planc�$approved by CI,.IP and ce�p3 of IR�GD permit � <br /> _.. _ _ _ _._1 <br /> f �ock.Commercial ', t Structural plans for the dock - ' <br /> 2 Survey showlr:g Ihe pr�poseci locatinn oi Ihr;dock <br /> 3 Gopy of�MCC?pnrrr7dt <br /> ; : . __-- _ ------_ <br /> _...,,....._----�_.._; <br /> ! Driveway Permit 1 AII Minor or Ma�or Land Alteration Perrnit r�quaremer7ts <br /> i � <br /> � � PProveci by Cpnditi�rc�and prr���osed <br /> 2 Hardcover calri�lat�ons e x+st <br /> � 3 nriveway�ta�5 ; <br /> _.___ ___ __. .....___.___.._.._'_._..__.____�.. <br /> Land A�teration, Ma'ar 1. Plans as a ir�nal U.r!�cr+nft <br /> ! 2. Fr<asic�n cr�r�lrnf pl�n or cotry af MCb'JD Eros�on Control Permil <br /> � _ _i <br /> Laand Alkeration.Minor ! 1 Gradinq pian including ex�stiny and�ircr�7t�5Fcf contaur, <br /> (i_F=ss,th�n i0 4u yds.wilhin 75'�f 2 Am�urii�1 tili t�b��mpc�rted artc��or exportect and hau)route <br /> lake or less ihan 5t>7 cu y�is � 3 An7�unt of e�rth to be nioved around t�ra�„�t� � <br /> I elsewh�re) ' d Erosion conirol plan or co��y o(M(;b"JC7�rcysi�irt Conirol F�ermif <br /> ___. _.__ f _ __ ._.._._., <br /> � Retaining Wall � 1 Plans iqr wati(sY . � <br /> 2. Unlnss repair or exact replac;om�nt c�F cxi,tirrg wali, submit an u�dated sur�ey wiih � <br /> � ' grading pl�r7 rrzr.ludir7g�;xi�tinq arra prop�sed conicurs I <br /> � 3 !-larelcc�ver calculatron wurksheets if in sharelanci distriCt � <br /> ' �4 Erc�s�on control plar7 or copy of M�WD Erusrar7 Ccrntroi Perrnd � <br /> _.. ._ _._--- — _ __ _. . ___ ____ __ <br /> Stainvay to lako } �arr5ln,ar..Uim�I<ins tar stair,vay. including loot�nr�s <br /> � � 2 Topograph�r.al survey ot propArt�y 4vifl7 prc�r,yt>sr�d;�tairs sli�tivrr I <br /> I 3 Erosipn c��titrrJi Grian cx copy of Mt�WC?Frosion Contmi Permrt � <br /> '-- . ____ __-- -+---..._ _.__. _.. _..._.. _ _ : <br /> Strueture Parmit ! i Plans for SUuc:ture <br /> 2 Survey al prc�perfy w�",h prc�nr?sed slruct,ir�shown and wiii7 setbacks ta pronerty <br /> � ; tinHs.othee s3ructur�s on property and thE sepUc systEm Frirlic�aied Tl�e gor�eral � <br /> locat�on of any sewer and water services shc�uid�e shown�f appiicable <br /> � '' 3 Grariing pian i`gradinc�is rey��rred <br /> ; li hiardr.pv�r calcuiation worksheets 1(in shoreland�Jistnct � <br /> '�roe Rttmovat Cali ��?�nn rn�trol�lan nr t n��y�f MOth3p Em�n�r'r Cnntrni Perm�t 1 <br /> 5 Eros <br /> r-- _.._...__ _ . _. . _. ---� <br /> � .-74A-d13t)�tt�!.r I�ea��Jule�vinyiv tre>e r�mp,rat msper,t+on !�re-planGng pi in! <br /> ( mamgemr�nt piar�ruquln��;!I;��r r�i�r;�r cutGrMa,t�uckihatn�r cittir;�Iriliar�sive vogclahcnr r�mtwa! � <br /> lipdalwf per.ember 3i1.1ft71 <br />