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Sl"RUCTURE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimens(ons(continued) 2.Type of Constructlon <br /> a.Length(ft.)= C a Number of bedrooms=_� _ ��yood/Frame <br /> b.Width (ft.)= � Number of garage stalls: []Masonry <br /> Areas in sauare feet Attached= � ❑Metal <br /> ❑Pole Bldg. <br /> c.Basement= '1�.�I Detached= ❑!CF <br /> 8� � <br /> d.1 St�ry = v ❑On-sita Prefab <br /> e.2nd Story= ��L ❑Off site Prefab <br /> f. '/z Story = ❑Other(piease specify): <br /> g.Total Area= tJ 0-�.Z <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your a lication to be processed: <br /> Not <br /> Enclosed A Iicabte <br /> ❑ Permit A Iicatlon <br /> � ❑ Pro osed Buiidin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> ❑ Surva meetin all re uirements <br /> ❑ � Stormwater Pollution Prevention Pian <br /> � ❑ Hardcover Caiculat(on s <br /> ❑ �7 Se tic S stem Site Evaluation Re rt <br /> p �' Access Permit <br /> ❑ a Wetland 8uffer Im rovement Plan <br /> ❑ @s En ineered Plans for Retalnin Walis 4 feet or above <br /> ❑ CJ Minnehaha Creek Watershed D(strict Permit s <br /> ❑ Pian Review Fea <br /> ❑ ❑ Application Escrow&Agreement <br /> ❑ 0 Other: <br /> APPLICANTIOWNER ACKNOWLEDGEMEN7: <br /> . Agrees to provide all inforrnation required or requested by the Building Department; <br /> . Agrees to pay the City of Orono for engineering consuttant review costs in excess of$500; <br /> . Certifies that the informatton supplied is true and correct to the best of his/her knowledqe. The appiicant recognizes that they <br /> are solely responsible for submitttng a complete application being aware that upon failure to do so,the staff has no alternative <br /> but to reject it until it is complete; <br /> • Acknowledges the Escrow Agreement is completed and signed; <br /> • Understands some or ali of the information that you are asked to provide on this application is classifted by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public but can 6e given to the subject <br /> of the data. Confidentfal data is information which generally cannot be given to either the publio or the subject of the data. Our <br /> purpose and Intended use of this Infor �ion is to annually update our records and records of other govemmental agencles <br /> required by law. If you refuse to supp �the information,the application may not be issued. <br /> / <br /> . Agress that in the event that�1 ather other conditions preyent the completlon of an as-buiit survey at the time the <br /> Certiflc� cupancy iS� quest , temPorery Certiflcate of Occupancy mey be issued upon receipt of a$10,000 <br /> escrow ta nsure mple(o of the buiit survey and a(I site tmprovements. <br /> ApplicanYs Signature: ` Date: O <br /> Owner's Signature: ' Date: � l^ <br />