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01/0?V2009 03:26 7634258859 MPS PAGE 03 <br /> STRUCTURE INFORMATION: <br /> 1.Struchn Dlnwrmlone 1.StrucUM Dimensions(continued) L Type of Construction <br /> a.Length(R,)n Number of bedrooms= ❑Wood/Frame <br /> Masonry <br /> b.Width(R.)= Number of garage stalls: Metal <br /> Attached= ❑Pole Bldg. <br /> Areas M samara teat Detached o ICF <br /> " On-site Prom <br /> a gasamenta Off-sh Prefab <br /> d. 1 u Story - Other(please specify): <br /> a,2nd Story= <br /> f. 'h Story = <br /> g.Total Area= <br /> REQUIRED SUBM11TALS: <br /> All of the information must be submitted in order for your applicedon to be rocessed: <br /> Nota .. <br /> Enclosed App9table <br /> 13 Pe It A catlon <br /> G E P osgd MINIM Plans <br /> pR MN State Emw Code Calculatlano and Me nivel Cale Requirements Form <br /> D <br /> S~ meeting all reimmenta <br /> D Hardcover loulati s <br /> [] <br /> SeNc System Site Evaluation Report <br /> 13 Q! Pe <br /> D lD Welland Buffer Impromment Plan <br /> D En Insered Plans for Retainina Walls 4 feet or above <br /> Plan Review Fee <br /> D P IOther <br /> APPLICANT A OWNER ACKNOWLEDGEMENT: <br /> • Agrees to provide all Information required or requested by the Building Department, <br /> • Agrees to pay the City of Orono for engineering consultant review oasis In excess of SM.and <br /> • Certify that the Information supplied Is true and Coned to the Crest of Mather knowledge. The applicant and owner recognize <br /> drat they are sot*responsible for submitting a oomph to appilostlon being aware that upon failure to do so,the staff <br /> has no alternative lotto valect n wdll R is oompkete. <br /> • <br /> Acknowledge the Escrow Agreement is completed and signed. <br /> • The Owner hereby acknowledges and agrees to this application and further authorlae reasonable envy onto the-property by <br /> City Staff,consultants or agents,for purposes of investigation of this request <br /> • Some or all of the inforrnatlon that you are asked to provide on this application Is classified by Stats luta as either private or <br /> confidential. Private doth Is information which generally cannot be given to the public but can be given to the subject of the data. <br /> Confidential date is information which generally cannot be given to either the public or the,subject of the date. Our purpose and <br /> intended use of this InIbimallop is to annually update our records and records of other governmental agencies required by law. <br /> if You Tule to,8001V the Infohnation.the application may not be issued. <br /> Applicant's Signature: <br /> Date; <br /> Applicant's Signature: Date <br /> Owner's Signature; Date: <br /> Owners Signature: per: <br />