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1r"' II City of Orono Building Permit Applications' for a Swimming Pool O�r Mailing Address: Permit number: app/V-4,0 48? VO PO Box 66 Crystal Bay, MN 55323-0066 Date received: ' I Street Address: Received by: ckv\ y 2750 Kelley Parkway Plan review fee: t'rk'Ism o�� Orono, MN 55356 apN Total Fee: i Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us MW This application form must be completed in full and all required information musf be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: 2 Q Q Lr ", E '�1A TR,g.6 CONTRACTOR/APPLICANT INFORMATION: Name: :3 K5 /0-00's State License# A"At Expiration Date: Phone: "263 – 052 -43U Fax: ( C32 0 Address: ra o'f' ^v Ci ZIP: S 3i Contact Person: "?`�-otR t ty*t-G4 oeo Contact's phone number / _ & Email: N oaJ e- Applicant is: o Facto � Homeowner (Circle one) PROPERTY OWNER INFORMATI N: Name: �_ jjoU -+ 511 s Phone (day): 2 12— 633f-, , ��, Mailing Address: no ;Q,, �/� 7+ tet, Q IC�a v►1 ZIP: Eff Email and/or Fax: �— ENGINEER INFORMATION: Name: a- Loi S .Ja XA Phone: lie Address: i W City: ZIP: Email: ' l.. Fax: AJ� PROJECT INFORMATION: 1.Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? X feet .Single Family [IAbove ground [Iyes no Height " 2.Heated? ❑ Multiple Family/Condo %In-ground *A building permit is required yes ❑ no ❑ Public for any wall over 4 feet in ❑Other(specify) height measured from the 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top ❑ Industrialof the wall, even if it replaces removed from site 6.Sewage Disposal& an existing wall. .used on site ❑ Other: (specify) Water Supply Tiered walls are considered ❑Other: (specify) ❑ Public Sewer one wall unless they are separated by twice the height (Private Sewer of the higher wall. 13Total Cubic Yards ❑Public Water Private Well Estimated Construction Value $ Ey Packet Last Updated: 03/29/13 Page 19 of 21