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STRUCTURE INFORMATION: <br /> 1. Structure Dimensions 1. Structure Dimensions(continued) 2.Type of Construction <br /> a. Length(ft.)= 75 Number of bedrooms= 5 ■❑Wood/Frame <br /> b.Width(ft.)= 65 Number of garage stalls: 0 Masonry <br /> Areas in square feet Attached = 4 0 Metal <br /> ❑ Pole Bldg. <br /> c. Basement= 1860 Detached=0 ❑ ICF <br /> d. 1st Story = 1600 <br /> 0 On-site Prefab <br /> e.2nd Story= 2117 <br /> 0 Off-site Prefab <br /> f. '/2 Story = <br /> 0 Other(please specify): <br /> g.Total Area= 5577 <br /> REQUIRED SUBMITTALS: i ,,,-----(i0 <br /> All of the information must be submitted in order f <br /> Not <br /> Enclosed Applicable <br /> //0 ---- <br /> p� <br /> ❑ ❑ Permit Application //(//J <br /> ❑ ❑ Proposed Building F <br /> ❑ ❑ MN State Energy CI L,L-- <br /> ❑ ❑ Survey(meeting all +.0likA,6 l <br /> ❑ ❑ Stormwater Pollutio l <br /> ❑ ❑ Hardcover Calculati <br /> ❑ ❑ Septic System Site <br /> ❑ ❑ Access Permit itt—S Lj <br /> ❑ 0 Wetland Buffer Imp' .!ro 0" <br /> ❑ ❑ Engineered Plans ft <br /> ❑ ❑ Plan Review Fee 1 <br /> ❑ ❑ Other: 6 60/ <br /> APPLICANT/OWNER ACKNOWLEDGEMENT: l <br /> • Agrees to provide all information required or reques G 2) 5 / <br /> • Agrees to pay the City of Orono for engineering ` 11 <br /> • Certifies that the information supplied is true and cthey <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-built survey at the time the <br /> Certificate of Occupancy is requested, a temporary Certificate of Occupancy may be issued upon receipt of a $10,000 <br /> escrow to ensure completion of the as-built survey and all site improvements. <br /> 1 <br /> Applicant's Signature: i <br /> `'t ' )1/7-- Date: 1-22-15 <br /> Owner's Signature: Date: <br />