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City of Orono 220 <br /> Building Permit Application <br /> for a Swimming Pool <br /> Mailing Address: Permit number: <br /> 0 PO Box 66 2-0 <br /> loft Crystal Bay, MN 55323-0066 Date received: <br /> �. Street Address: Received by: 94 <br /> Gtiti 2750 Kelley Parkway Plan review fee: <br /> t9AESH0 Orono, MN 55356 <br /> Total Fee: �0. f <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 sub <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �s � cvti <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: )-g S �°oml�S G.� <br /> State License# ^ /,+- Expiration Date: <br /> Phone: 7 6;? _ G 81.-(fZq-7 Fax: 2 i s,- 6 8 a- o g 6 7 <br /> Address: t,10 .5: c.^o &.-f .9 v 4/w City: 8 �,,L�,� ZIP: SS-7 <br /> Contact Person: TC-T P-V ,�.��y o,J Contact's phone nu_m_b&r y r frs <br /> Email i„0.,-V a- Applicant is: rtonfr-a-ttr Homeowner (Circle One) <br /> PROPERTY OWNER 17ORMATION: p <br /> Name: e fe— c� <br /> Phone (day): <br /> Mailing Address: a. $'i/dE-� //l w R ZIP: <br /> Email and/or Fax <br /> ENGINEER INFORMATION- <br /> Name: Iro r r' ryg pajjC �'f w.¢ ..,� /r- <br /> Phone: <br /> _Phone: <br /> Address: City: ZIP: <br /> Email V Fax: <br /> PROJECT INFORMATION: <br /> 1.Pool Dimensions: 4.Accessory to: 5. Pool Type: 6.Sewage Disposal& <br /> ` X feet Single Family E]Above ground Water Supply <br /> ❑ Public Sewer <br /> 2. Heated? El Multiple Family/Condo PkIn-ground <br /> [ ,yes ❑ no El Public [�Private Sewer <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial 4W ❑ Public Water <br /> ❑ removed from site <br /> ❑ Industrial 6. Retaining Walls? ❑ Private Well <br /> ,used on site ❑ Other:(specify) <br /> ❑ yes [jj no <br /> ❑ Other: (specify) <br /> Height <br /> Total Cubic Yards <br /> Estimated Construction Valuation $ 513/ '0047 <br /> Last Updated: 10/28/2010 <br /> -7- <br />