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� <br /> STRUC'�URE INFORMATION: <br /> 1.Structure Dimensions 1.Structure Dimensions(continued) 2.Type of Construction <br /> �—� <br /> a. Length(ft.)= �_ Number of bedrooms= � <br /> �c�u,�a� c ��C--� <br /> b.Width(ft.)= � Number of garage stalls: I , � <br /> Areas in square feet Attached= z . �� ��J` L��� ` ��y <br /> �a' 7 �� G <br /> c. Basement= �✓Li I Detached= <br /> d. 15�Story = 1 � <br /> e.2"d Story= -- --- <br /> f. %Story = � �•• • • - <br /> g.Totai Area= �'Z. <br /> REQUIRED SUBMITTALS: <br /> All of the information must be submitted in order for your application to be processed: <br /> ., , <br /> Not <br /> `Enclosed A `licable 's <br /> '� ❑ Permit A lication <br /> � ❑ Pro osed Buildin Plans <br /> � ❑ MN State Ener Code Calculations and Mechanical Code Re uirements Form <br /> � ❑ Surve meetin all re uirements <br /> ❑ ❑ Stormwater Pollution Prevention Plan <br /> ❑ ❑ Hardcover Calculation s <br /> ❑ ❑ Se tic S stem Site Evaluation Re ort <br /> ❑ ❑ Access Permit <br /> ❑ ❑ Wetland Buffer Im rovement Plan <br /> ❑ ❑ En ineered Plans for Retainin Walls 4 feet or above - <br /> ❑ Minnehaha Creek Watershed District Permit s <br /> � ❑ Plan Review Fee <br /> ❑ ❑ Application Escrow&Agreement <br /> ❑ ❑ Other: <br /> APPLICANT/OWRER ACKNOWLEDGEMEMT: <br /> • Agrees to provide all information required or requested by the Building Department; <br /> • Agrees to pay the City of Orono for engineering cnnsultant review 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 solely responsible for submitting 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 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 but 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,the application may not be issued. <br /> • Agrees.that=in the event that weather or other..conditions,prevent'the'completion:of an;:.as-tiuiit�survey:at the=time:the <br /> Ceifificate,of:Occupancy:is:requested;a'temporary'Certificate:of'.bccupancy:may:6e issued,upon.receipt of a$10,000 <br /> escrow to ensure completion of;ttie:as-built suryey,and all site improvements. <br /> �� ,�_ '�� i <br /> Applicant's Signature: " `'�� Date: �`--J (�� 7 <br /> Owner's Signature: Date: <br />