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! <br /> STRUCTURE INFORMATION: <br /> � 1.Structure Dlmenslons t.Structure pimenslons(continued) , <br /> a. Length(ft.)= �l� ' Number of bedrooms= -3 2. Occupancy :5yc � , c. <br /> a W�dih(ft.)= ,J / Number of garage stalls: � <br /> � � ; 3. Occupant LoaC: <br /> , Areas in spuare feet I Attached=�_ I � �7� <br /> I ! .- I /� <br /> I c. Basement= v'� � � ! De;ached= � � � 4. Type of Construaion <br /> j d 1"Story = � � � �y, <br /> � e.2"�Story= "" " � � 5. Code Edi;ion. �V� � <br /> f. %:Story = �- G I <br /> g.Total Area= -„��� � <br /> � I <br /> REQUIREO SUBMITTALS: <br /> Ali of the information must be submitted in order for your application to be processed: <br /> i Not <br /> � Enclosed A licable j <br /> ,67�' ❑ Building Perm,t Escrow Agreement anC Fes& <br /> �' ❑ Plan Review Fee � <br /> � ❑ Com fetetl A ��catian Form i <br /> � ❑ Proposed Build.nc�P ans-2 full size sets to scale ana 1 reduced 11 x 17 or B Y:x 11 set ' <br /> , � ❑ ❑ �Minnesota State Enerqy Coae Calculatio�s an�MeChanical Code Requirements � <br /> ��'" ' ❑ r urvey-2 fuli size tc scale(meeting AlL survey�eqwrements} i <br /> G � Harecover Calculatio�s <br /> ❑ � 6iJ Se tic S stem Certifrcation ` <br /> ; i C Minnehaha Creek VJatershed District(MSCWD)Permit or <br /> � Documentation from MCWD staDn no ermit is r uired <br /> O � Landsca e WaAs and-or Retainin Wa0 Pians <br /> ' � � Stormwater Po�iution Prevention Plan SWPPP <br /> ❑ � Access Perm�t <br /> ❑ � �d � Data Privacy Adv�sory Form ' <br /> _ I <br /> APPLICANTIOWNER ACKNOWLEDGEMENT: <br /> . Agrees to provide all infarmat�on requ�red ar requested by the Buiid ng DepaRment <br /> • Ag�ees to pay the City of Orono for engineering consultant review costs in excess of S500; <br /> • Certifies that the informa;ion suppbea is true and correct to the besi of his/her krowledge. The appiicant recognizes that they are <br /> solely resporsible for submitting a ccmplete appli;afio�being aware that upon faiiure to do so,the staff has no altemative but ta <br /> reject it until it is compiste: <br /> • Acknrnv!edges the Escrow Agreement is comple:ed an�signeo. <br /> • Understands some or all of tt�e intormat�on that you are asked to provlde on this applicatron is ciassified by State law as either <br /> pnvate or confidenuai Private da:a is�nfermation which generaNy cannot be given to the pubiic but can be given te tne subject of <br /> the tlata. Confldennal data is:nfortraUon which generally cannot be giuen to either the public or the subject of the data Our <br /> qurpose and �ntended use of this information is to annually upcate o�r records and records of other governmentai agenaes , <br /> required oy law !f you eefuse,a suppiy tre intormatiCn,the applica6on may not be issued. <br /> � <br /> • Agrees that in the event that weather or other conditions prevent the compietion of an as-trulEt survey at the tEme the ! <br /> Certificate ot Occupancy is requeated, a fcsmporary Certificafe o(Occupancy may be iaeued upon recelpt oi a$10,000 + <br /> eacrow to ensure completion of the as-built survey and ali aite impravements. � <br /> :� <br /> AppiicanYs Signature� � Date: �r'"" �1��—1�' <br /> � <br /> Owner's Signature: ��� �' Date: <br /> Last Uptlafe0: January 2D16 <br /> �1�r�_J� 5 V t= �T` `� i., S� t;'.�.h;(�4c_,.1+ �`..� �, <br />