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, t <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> O�T Mailing Address: Permit number: oZ 0 I3-00 7 0 <br /> 1 VO PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 13 <br /> Street Address: Received by: tp <br /> 2750 Kelley Parkway Plan review fee: Z 5b <br /> �lgkFSHo`� Orono, MN 55356 ZDt 3 U 670,3Total 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: <br /> CONTRACTOR/APPLICANT INFORON: <br /> Name: _ �j t�� •d- A <br /> State License# Expiration ate: <br /> Phone: Fax: i 3 ' L <br /> Address: Cit : ZIP: <br /> Contact Person: Contact's phone 51 S-'� <br /> Email: w Applicant is: ontractor Homeowner (Circle One) <br /> PROPERTY OWUEI INFORMATION: <br /> Name: J_�foflz, <br /> Phone (day): <br /> Mailing Address: �5��� '� �� � Q�pn� /�,v�5 5 ZIP: <br /> Email and/or Fax: <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 /> 26> X -"46 feet ❑Single Family Above ground yes El no Height3-6 <br /> � <br /> 2. Heated? ❑ Multiple Family/Condo In-ground *A building permit is required <br /> /19 yes ❑ 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 /> ❑ Industrial of the wall, even if it replaces <br /> removed from site 6. Sewage Disposal & an existing wall. <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 /> Ida <br /> Estimated Construction Value $ 151,E <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />