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09/30/2010 THU 8� 42 �.A.X 507 665 3775 6e�vex Coimp�ny �003/003
<br /> STRUCTURE INFORMATION:
<br /> 1, Structuro Dlmensipns�~ 7.Structure Dimwrizfoiis(continuedj' 2,7ype�of Cons4ruttion���y�
<br /> a. L�nglh(ft.)= Numbar of bOtll'obms= []Woad/I�rame
<br /> (]Masorny
<br /> b.Width(ft.)- � Number of g�rage stalls: Melai ....
<br /> � Attached=" " � � Polc pldg.
<br /> �,,,�r 'i s �ra fee Detachod=�,,,,, � ICF
<br /> C. 68sem6nt� �On-site Pref�b
<br /> ----T..— ❑Otf-slte Pr4fab
<br /> d. 1 e1 SIOry � ,,,,� �]Oth�r(plCaso sp�cify): �
<br /> n. 2"`�Story`
<br /> f, %a Stot'y =
<br /> g.Tolal Area= �
<br /> RE�UIRED $UBMITTALS:
<br /> All of the information �rust be submitted in order for your application to be process�d:
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<br /> Ena�osod , Applicable
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<br /> �-�,•••,� „A � M, Prol�osed Su ing Plens
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<br /> _.._..„. �,.,„ SUNQy_ meetin. all rsE�ui�om�ntc,_._,..w�
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<br /> „„,� .__ __ S o mwater Poliution'Pr�vontion Plpn �
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<br /> _ ,,.....�,�„ ___.,,.. Se tic Systo i Sile Evaluation genort..�,�.
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<br /> � ._�„ti, Ci ngineered Nlans for Retorning Well�4 f�ot or above
<br /> � ❑ � �lan Review Fpo ��� '— ---""'
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<br /> APPLICANT ACKNOWLEDGEMENT�„ ___, x� M
<br /> • Agrees to provide t�ll information raquired or requesied by the nuilding Dep�rtment;
<br /> • A9roas to pay thn City of Orono fvr enginao�ing conSulkltlt revleW cnsts in exCess of$600;
<br /> � Certifios ihat tho inforiretion supplied is truo a�d corrpCt to Ule beSt Of his/ner knbwlodg�. The epNlicant recognPzes ihat they
<br /> a�a �ofely res�ponsiblp for cubmitUr,g a complet� applicallon bcing aware th�t upon failure to tlb Sq, the staff has no altarnative
<br /> but t0 reJ�C[�l until it is complQta;
<br /> • ACknpwlOd�es the CsCrOw Agroomenl is complsted�nd signed;
<br /> • Some or atl of the fi�formaiion Lhal you are asked to provide on this applic3tion is classifed by State I�w �s cither privata or
<br /> confide�ntial, Private dAta is inform�tion wniGi goner�Ily cannot be gi�en io tfle publie but ean bo given to thv subject af the date.
<br /> Confidantial dsta i,� informetlon which genorally cannot be glven to eithor the'publie or tho subject of th�data. Our purpose�i�d
<br /> tn4ondad use of this informetion is lo �,nnually updat� our records anQ records of Oth�r�overnmentel ageneies rQqulred by lew,
<br /> If you rGfuse to supply the information,the appl(cation mey not ba iasued. �
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<br /> ApplicenCs SiQnawre: �»����� , I�ate:
<br /> laGt Updatod: 9I25�/2009 �
<br /> - 18 -
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