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STRUCTURE INFORMATION: 1.Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction a. Length(ft.)= Number of bedrooms Wood/Frame b.Width(ft.)= -,15' Number of garage stalls: ❑ Masonry Areas in square feet Attached= * I ❑Metal c. Basement= 353 etached= Q El Pole Bld . ❑ ICF d. 1St Story = 25? 2� ❑ On-site refab e. 2nd Story= I c El Off-sit Prefab f. %Story = ❑ Other(please specify): g. Total Area= -61-71 REQUIRED SUBMITTALS: All of the information must be submitted in order r your application to b processed: Not Enclosed Applicable ❑ Permit Application ❑ Proposed Building Plans 1] ❑ MN State Energy Code Cal lations and Kochanical Code Requirements Form '�D ❑ Survey(meeting all re uirem nts ❑ IKI Stormwater Pollution Preventi Plan ffi ❑ Hardcover Calculation(s) ❑ Septic System Site Evaluation Re o ❑ Access Permit ❑ Wetland Buffer Improvement Plan ❑ Engineered Plans for Retaining IIs feet or above ❑ Minnehaha Creek Watershed Di trict Pe it s ❑ Plan Review Fee ❑ Application Escrow&Agree 2±nt ❑ ❑ Other: APPLICANT/OWNER ACKNOWLEDGEMENT: • Agrees to provide all information reZrmation or request by the Building Departmen\issued. • Agrees to pay the City of Orono fineerin onsultant review costs in ef$500; • Certifies that the information supplirue an correct to the best of his/her ke. The applicant recognizes that they are solely responsible for submittinmplet application being aware that upto do so, the staff has no alternative but to reject it until it is complete; • Acknowledges the Escrow Agreemo pleted and signed; • Understands some or all of the infothat you are asked to provide on thistion i classified by State law as either private or confidential. Private datarmation which generally cannot be givepubli but can be given to the subject of the data. Confidential data is infon which generally cannot be given to epublic r the subject of the data. Our purpose and intended use of this tion is to annually update our recordscords of ther governmental agencies required by law. If you refuse to sue information,the application may not b . • Agrees that in the event that weather or other conditions prevent the completion of an as-built survey at the time the Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 escrow to ensure completion of the as-built survey and all site improvements. Applicant's Signature: Date: AA^W 15-1 toy Owner's Signature: Date: