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City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> �0 Mailing Address: Permit number: p�P`F 00-315 0 <br /> PO Box 66 p <br /> Crystal Bay, MN 55323-0066 Date received: 3 v O <br /> �l' b Street Address: Received by: G <br /> y� ti 2750 Kelley Parkway Plan review fee: <br /> SHO��G Orono, MN 55356 0210 _ 003 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: <br /> CONTRACTOR/APP,LrICANT INFO,k2M,QTION: <br /> Name: P,/? si76 c- S <br /> State License# Expiration Date: <br /> Phone: 6S/-y90 i3Q4 Fax: <br /> Address: City: T' ZIP: �- <br /> Contact Person: nit Contact's phone number _ G/� 7--70_i7 z 3�— <br /> Email: a Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: 14- D. "A-, * --� <br /> Phone (day): /007o Tar�i«:,v.4 <br /> Mailing Address: 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/ Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> /41 X 3r- feet <br /> 2. Heated? yes ❑ no ❑Above ground El yes no Height <br /> �-Single Family � i <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo 9�In-ground "A building permit is required <br /> removed from site for any wall 4-feet or greater in <br /> used on site El Public ❑ Other(specify) height measured from the <br /> ❑ Other: (specify) ❑ Commercial bottom of the footing to the top <br /> Total Cubic Yardsof the wall, even if it replaces <br /> ❑ Industrial 6.Sewage Disposal& an existing wall. <br /> ***Any earth movement may require ❑ Other:(specify) Water Supply <br /> Tiered walls are considered <br /> MCWD review and permits. <br /> one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) ❑ Public Sewer <br /> separated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 55345 El Private Sewer of the higher wall. <br /> Phone: 952-471-0590 <br /> El Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org ❑ Private Well RECEIVEn <br /> Estimated Construction Value $ <br /> Packet Last Updated., April 2016MAR � n �(tl 1., <br /> Page 22 U <br /> CITY OF ORONO <br />