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STRUCTURE INFORMATION: <br /> ! 1.Structure Dimensions 1.Structure Dimensions(continuedj 2.Type of Construction <br /> ' a. Length(ft.)= '��D Number oS t�ed►twrns = [l�VVoo�i/f-ram� S\��'� ra,�- <br /> � �Masonr�---- \�'�` ��.rr" <br /> b. Width (ft.)= �� __ Number of gara4}e stails: (1 Metai <br /> Attached= _ _ (� �ole Bldg. <br /> Areas in square feet vetached=_� L{ IC;� <br /> ❑On-site Prefab <br /> c. Ba��Pment= ❑C)ff-ciTP PrPf�h <br /> d. 1"�toiy -- S� �1 4ther(pte�e s�city}:. <br /> e. 2"� StOry = �V <br /> f. '/z Story = _ <br /> g. Total Area= <br /> REQUIRED SUBMiTTALS: <br /> Atl of the information must be submitted in order for your application to be processed: <br /> Not <br /> tnclosed Applicable <br /> ❑ C1 Fermit Application <br /> ❑ G I'iopuse:!LtuilcGng f'lans <br /> ❑ ❑ MN �tate Cner Code Calculations and Mechanical Cade 2e uiren��nts �orn� <br /> �'l t�l S��rv� rnnetin��t1 rrq,�ireni�nts) -- <br /> D t7 Hardc�ver Calc�44ation(s) <br /> - - - _ _ <br /> _ C1 D Septic. System Site Fval«atian Report <br /> -- --_ . <br /> ❑ ❑ Access Permit <br /> ( ❑ � Q Wetland Buffer imptovement Plan <br /> U � U �n�ineerec�F'lans#or Hetaining Wails 4 feet or above <br /> ----_. --- - -_ ----- <br /> L LJ ❑ F'fan Fteview F-ee <br /> � LJ � L1 � Other _� <br /> APPLICANT ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required ar requested by the E3uilding Uepartment; <br /> • Agrees to pay the City of Orono for engineering consuitant review costs in excess of 5500; <br /> • Certifles that the information s�i�lieci is true and correc:t to the t�t nf hislher knowlacic�Q. The a��ficant rer,ognizes that they <br /> are solely respansibie for submitting a camplete application being aware that upan 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 /> � S�rne or aA �f ti�c irtf:��rr.afi�ri th:�t yu� �re ��•��•cf tv prvvi:ic vr� tFtis a�>��!ica(i:��t is cfassificcf �s �t�te la��,� as eifF�er private or <br /> confidential. Private data is information which generally cannot be given to the public but can�given to the subject of the data. <br /> Confidential data is infoRnafion which generally cannot be given to either the public or the subject of the data. Our purpose and <br /> intended use of this informati is to annuatty upda our recor�s and records of other governmental agencies requir�d by law. <br /> If you rcfuse to su�;�1Y the it�f rn�bun, tt�c��;�;�:�iw��� i���y r�ot�e i:�su�;d. <br /> ^ <br /> ApplicanYs Signature: '' Date: S�-��-Cj� <br /> - 19- <br />