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RECEIVED <br /> �::;Cf C� 3 2011 <br /> City of Orono <br /> Building Permit Application CITYOFORONO <br /> for Swimming Pools and Hot Tubs <br /> �O^;� Mailing Address: Permit number: �.Dl 7—OI � <br /> 'VO�, PO Box 66 <br /> Crystal Bay, MN 5532 -0066 Date received: /V— — <br /> ��/ ,, ' � " ,'�Street Address: �,�� Received by: <br /> �,; ' �,►�^ �,;' � 2750 Kelley Parkway � Plan review fee: o� � , Q <br /> ! �"n \ ` �� Orono, MN 55356 <br /> �r:si�i��`��'� �� 0�01"]—Ol�.'.f <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: Z `�-Z� C1�c� ,�pce��, ���� �1;a�rb � {�i�i� <br /> CONTRACTOR/APPLICA T INFORMATION: <br /> Name: Ct l r'v �c��`:�t � Snaf <br /> State License# ���} —� Expiration Date: /V/fd <br /> Phone: 1s 2- E95F f��'� F.�� C�t1 l►I 2'' .3�0.3 — Ot073 <br /> Address: 3 Ut C%i{�1j,� � City: ,C3✓,��r��,`//� ZI P: 5 S"�3 3 7 <br /> Contact Person: �"� � �,��,��,� ContacYs phone number (p�Z--3�3— c�(a 7,3 <br /> Email: �jc�G,r� C�v''�c �t�tJ��fs• c cm Applicant is: Cont�cto Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: T.� � 5tc.tiq���ie�i� .� /�mV f�bj�✓e'fe�tit°�',�l <br /> Phone(day): _�% 2—���'—3 �'[��1� <br /> Mailing Address: Zs � � Y�a _r( i?��n o �7�� ZIP: s 3 <br /> Email and/or Fax: S� , S �� ` ` �vp ' / , ;�, �,c��e cr� .� c4 ` /s� ��� <br /> ENGINEER INFORMATION: <br /> Name: /��� <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Po��Hot TXb Di�rysions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> �" feet <br /> 2. Heated? �yes ❑ no �Single Family ❑Above ground �'yes ❑ no Height * <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo �In-ground "`A building permit is required <br /> ❑ removed from site for any wall 4-feet or greater in <br /> ,� ed on site ❑ Public <br /> ts ❑ Other(specify) height measured from the <br /> ❑Other: (specify) ❑ Commercial bottom of the footing to the top <br /> Total Cubic Yards ❑ Industrial of the wall, even if it replaces <br /> 6.Sewage Disposal 8� an existing wall. <br /> *""Any earth movement may require ❑ Other: (specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) ❑ PubliC Sewer <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka,MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 �Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or ❑ Private Well <br /> Estimated Construction Value $ �,5 j ���p, i� <br /> Packet Last Updated: Apri12016 <br /> Page 22 <br />