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City of Orono <br /> - <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> ��1 V Mailing Address: Permit number: <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: <br /> Street Address: Received by: <br /> 2750 Kelley Parkway Plan review fee: /lp <br /> Orono, MN 55356 <br /> `gxESH��O (::501(f' <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: 2 7v r <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 'X7,_'-AA-r1_-:5 <br /> State License# Expiration Date: <br /> Phone: 763 — p — o/o'3 Fax: <br /> Address: /0,Aar7 73an dv&0_ A-' CitY:/47,0,14 IP: <br /> Contact Person: Contact's phone n <br /> Email: A)G/FGr4r�oSn.Si`1sfG.CD�`T Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): _ <br /> Mailing Address: '7O� 6,1A GT/z/LS �Z� ZIP: S X21 <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 Dimensiorgs: 4.Accessory to: F5. ype: 7. Retaining Walls? <br /> X �Ll feet <br /> 2. Heated? ❑ Singno le Family bove ground El yes _4K Height <br /> 3. Excavated materials will be: El Multiple Family/Condo *A buildin <br /> ❑ removed from site In-groundg permit is required <br /> ❑ Publicfor any wall 4-feet or greater in <br /> El used <br /> used on site n0, �}- Other(specify) height measured from the <br /> JR'bther:(specify) Ae- �+'� ❑ Commercial bottom of the footing to the top <br /> Total Cubic Yards ElIndustrial T f.L1� f the wall, even if it replaces <br /> B.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) Q-Public Sewer <br /> separated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 Public Water <br /> Fax: 952-471-0682 G <br /> R�1 *`�rr��/ r� <br /> www.minnehahacreek.or E] R <br /> Private Well G <br /> Estimated Construction Value $ Q O , <br /> Packet Last Updated: April 2016 APR <br /> Page 22 CITY OF ORONO <br />