2012-00632 - pool in ground - Laserfiche WebLink

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. ` . City of Orono � (� Building Permit Application � � for a Swimming Pool Mailing Address: Permit number: � �='� L- — :�l.)�:�,� �,�,� PO Box 66 �/ Z 0 �il \\ Crystal Bay, MN 55323-0066 Date received: �1 Z � ��'�,�Y:;�, �, Street Address: Received by: I�-b �,c, ��j� �� 2750 Kelley Parkway Plan review fee: � � Z . c�� L�9kEgHpg�' Orono, MN 55356 Total Fee: Main: 952-249-4600 Fax: 952-249-4616 ww�av.ci.orono.mn.us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (P/ease print) GENERAL INFORMATION: Job Site Address: '� - ��U�S �7�T� CONTRACTOR/APP ICANT INFOR TION: Name: �t�---,., - c,� State License# C-�v �. � Expiration Date: �� t Phone: C� , a-a-� Fax: a - � _ 3 -. � � � Address: (� �.� 5',��r �� Cit : - : r ZIP: C c Contact Person: h��;,�v�c� Contact's phone number �-c_= ?, ' - ��,�cc- Email �� ;�,r-��> F�L�S�z„�,��IS�nc.- Applicant is: or Homeowner (Circle One) cr�vv� PROPERTY OWNER_ NFORMATION: � �` Name: � � ��. �, �� S L.�� F,t�� Phone (day): Mailing Address: � �`'3 � � ✓ t�=.�c-: - � ZIP: ��5 (r, Email and/or Fax �- ENGINEER INFORMATION: Name: Phone: Address: City: ZIP: Email Fax: PROJECT INFORMATION: 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal & Water Supply �X�feet ��ngle Family ❑ Above ground _ ublic Sewer 2. Heated? � ❑ Multiple Family/Condo �In-ground s ❑ no ❑ Private Sewer ❑ Public ❑ Other(specify) 3. Excavated materials will be: ❑ Commercial �Public Water moved from site ❑ Industrial 6. Retainin Walls? g ❑ Private Well ❑ used on site ❑ Other: (specify) ❑ yes ❑ no ❑ Other: (specify) . , Height Total Cubic Yards Estimated Construction Valuation $ _ � �� Last Updated: 10/28/2010 - 7 -