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� STRUCTURE INFORMATION: <br /> �1.Structure Otmensions 1.Structure Dlmenstons(corttinued <br /> ��� .��' y ) 2.Type of Construction <br /> a.Length(ft.j= ,_, Number of bedrooms= <br /> i <br /> b.Width(ft.)= p� �Wood/Frame � <br /> � Number of garage stalls: <br /> {�Mas�ry <br /> �as tn souare feet Attached= <br /> ❑Metal <br /> c.Basemenl= 'Z7C� Detached= ❑Pe�e Bldg. <br /> d. 1'�Story = •Z7C7 ❑ICF <br /> e•2"d Story= _ ❑On-site Prefab <br /> f• �Z S��Y = ❑Off-site Prefab <br /> g.Total Area= �v__ ❑Other(please specify): <br /> REQUiRED SUBMITTALS: <br /> All of the information must be submitted in order for our a ication to be rocessed: <br /> Not <br /> Enclosed Ilcable <br /> � � Permit lication <br /> � � Pro osed Buifdin Plans <br /> � � MN State Ener Code Calculalions and Mechanical Code Re uirements Form <br /> � � Surve meetin ali re uirements <br /> � O <br /> 0 Stormwater Pollution Prevention Plan <br /> � Hardcover Calculation s <br /> � Se tic S stem Site Evaluation Re rt <br /> � Access Permit <br /> � Wetland Buffer Im rovement Plan <br /> � � En ineered Plans for Retainin Wafls 4 feet or above <br /> � �: Min�ehaha Creek Watershed District Permit s <br /> � Plan Revtew Fee <br /> � � O <br /> � AppUcatlon Escrow 8 Agreernent <br /> � Othar. <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provide all iniormation required or requested by the Bullding Department; <br /> • Agrees to pay the City of Orono for engineering consultant revPery costs in excess of$500; <br /> • Certifies that the information supplied is true and correct to the best of his/her knowledge. The applicant recognizes that they <br /> are salely respansible for submltting a complete applfcation 6eing aware that upon failure to do so,the staff has no aftemative <br /> but to reject it until it is camplete; <br /> • Acknowledges the Escrow Aqreement is completed and signed; <br /> • Understands some or a!I of the information thai you are askecl to provide on this application is dassified by State law as either <br /> private or confidential. P�vate data is information whtch genera(►y cannot tre given to the public but can be given to the subject <br /> oi the data. ConfidenUal data is informa6on which generally cannot be given to either the putrlic or the subject of the data. Our <br /> Pu►Pose and intended use of this information Is to annuafly update our records and records of other govemmental agencies <br /> required by law. If you retuse to supply the infomiation,the appliCation may not be issued. <br /> • Agrees that tn the event that weather or other condhtons preyent the completlon of ap as.built survey at the time the <br /> ����te of Occupancy is re uested,a temporary C@runc�of Occupancy may be tssued upon recetpt of a$10,000 <br /> escrow to ensure comp�etion the as-bu{It survey and afl site fmprovements. <br /> Applicant's Signature: � � � <br /> ,� Date: <br /> Owner's Signature: � <br /> Date: _/Z�`fl/� <br />