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City of Orono � _ <br /> Building Permit Application �� �S <br /> for a Swimming Pool <br /> ���� Mailing Address: Permit number. ���- ��� <br /> PO Box 66 � <br /> � Crystal Bay, MN 55323-0066 Date received: � � <br /> ( Street Address: Received by: � <br /> � �' � 2750 Kelle Parkwa <br /> � � � O, Y Y Plan review fee: 3 C�3_3 G( <br /> �t,� � � Orono, MN 55356 a0(3- -1 <br /> �FS►�o � O <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: ��(� ����W d dQ/ ��p( <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: �/C-��/¢?7�/�E- ,�DOLS �7'�. <br /> State License# iV Expiration Date: <br /> Phone: S - 7 - �7 � Fax: - D � <br /> Address: /' Cit : S!D IP: <br /> Contact Person: E - Contact's phone nu - , - S <br /> Email: yn�/ o� ; n S cd. A licant is: ntracto Homeowne� (circ�e one) <br /> PROPERTY OWNER INFORMATION: Q <br /> Name: e-/9 Sf�l�l/�}"� �'�L �lZf��i/�'� <br /> Phone(day): - o r � /�Z- S'o - 3 <br /> Mailing Address: �/�DD / / rY1 ZIP: <br /> Email and/or Fax: ,/" G/ /'G �-{�.�'�'12. <br /> � CO i'� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION• <br /> 1.Pool Dimensions: � �/�� 4.Accessory to: 5.Pool Type: 7. Retaining Walls? <br /> X feet �ingle Family ❑Above ground ❑yes �no Height ' <br /> 2.Heated? ❑ Multiple Family/Condo ❑ In-ground *A building permit is required <br /> �ies ❑no � public for any wall over 4 feet in <br /> �.Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑Commercial /������;\ ��� bottom of the footing to the top <br /> J of the wall, even if it replaces <br /> ❑ Industrial 6.Sewa e Dis osal 8 an existin wall. <br /> removed from site 9 P 9 <br /> ❑used on site ❑Other: (specify) Water Supply Tiered walls are considered <br /> ❑Other:(specify) �Public Sewer one wall unless they are <br /> separated by twice the height <br /> /� ❑ Private Sewer of the higher wall. <br /> Total Cubic Yards �Public Water <br /> ❑ Private Well <br /> Estimated Construction Value $ �n � <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />