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" ST'RUCTUR� INFORiVIA`TION: <br /> 1.Structure Dimensions 1.Sfiructure Dimensions(continued) 2.Type ofi Construction ��� <br /> a. Length(ft.)= �(�3 Number of bedrooms= � <br /> �// ' /� ,/ <br /> b.Width(ft.)= ��_ Number of garage stalls: �G�,��n� � � <br /> Areas in square feet Attached= � . ^ �-CJ`� �� �� <br /> 7. <br /> c.Basement= ���'�. � Detached= � .—..- . <br /> d. 1S�Story = O.�f✓�' � - <br /> � <br /> e.2°d Story= . <br /> f. %z Story = � — ,�: <br /> g.Total Area= 3 3 � S <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> . .. �i�lot°:.:::::: . . . <br /> �:'`:;.; _ <br /> �. ....... <br /> ` 'Enctosed; .. ,.:.y><:,::....���:,:.:,.: <br /> . . <br /> .�: . <br /> . . <br /> �. .:_�:::::A~; IicabTe:�`.;: :: <br /> . .. .. ,: . .,.. <br /> .... . . . . <br /> � ❑ Permit A lication <br /> �[ ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanicai Code Re uirements Form <br /> ❑ 8urve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation s i <br /> ❑ ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit i <br /> � ❑ Wetland Buffer Im rovement Plan <br /> � ❑ En ineered Plans for Retainin Walls 4 feef or above <br /> ❑ Minnehaha Creek Watershed District Permit s <br /> ❑ Plan Review Fee <br /> ❑ ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICANT/OyllNEl�ACKNOWLEDGEMENT: <br /> • Agrees to provide all information required or requested by the Building Departmenf; <br /> • Agrees to pay the City of Orono for engineering c�onsultant review cosfs in excess of$500; <br /> • Certifies that the information supplied is frue and correct to the best of his/her knowiedge. The applicant recognizes that they <br /> are solely responsible for submitting a complete application being aware thaf 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 compieted and signed; <br /> • Understands some or all of the information that you are asked to provide on this application is classified by State law as either <br /> private or confidential. Private data is information which generally cannot be given to the public buf can be given to the subject <br /> of the data. Confidential data is information which generally cannot be given to either the public or the subject of the data. Our <br /> purpose and intended use of this information is to annually update our records and records of other governmental agencies <br /> required by law. If you refuse to supply the information,fhe application may not be issued. <br /> . _ ... .. ..:: : . ....... .. .. .. . <br /> •• Agrees.ttiat:.in:the.:evenf.tfiaE:weather or:other�conditions,prevent,tfie compietion'.of;an'�as-tiuilt:sucvey:`at:tiie;time:;tlie <br /> . �. .•..,.. . .... ..- _ . .... .. . � ..... , : <br /> Certificate;of::Occupancy:is:requested;,'a,temporary;Certificate�of.';Occupancy;may.�6e issued:�:upon;receipf of.=a$1O;OD0 <br /> eserow.to�ensure.complefion.:of;ttie:as-tiuilt survey:and all sife improvements: <br /> Applicant's Signature: d�" Date: ���•���' <br /> Owner's Signature: Date: � <br /> I <br />