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City of ( <br /> Building Permil <br /> for Swimming Poof �, ibs <br /> �O� Mailing Address: ,\n� number: a 0/4 —0/3.39 <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-01 <br /> V ceived: �/ 2-°//.O/i, <br /> Street Address: c` may: ' <br /> y� , 2750 Kelley Park hew fee: .3 LJ/�. 5? <br /> �' Orono, MN 55356 <br /> Total Fee: 71 <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) ( 14Sy/r y-/,, <br /> GENERAL INFORMATION: <br /> Job Site Address: -5 Plite p/ .�,cv i lie <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: 3-RC pools' L C- <br /> State License# Expiration Date: <br /> Phone: ,76 3 - &8,4 — (te ?F ? Fax: -7 k 3 -- e} 47 j FS�L <br /> P: <br /> Address: - ' c3 r , I 44, Cit : _ ZI <br /> Contact Person: 418sMI117 Contact's phone - <br /> Email APO got)i Applicant is: ontractor omeowner (circle One) <br /> PROPERTY OWNER INFORMATIONy_— , <br /> Name: Al.4 t `1- Jen/ /O 4 Cj%u,1.5 t'-. <br /> Phone (day): q6), ,3 0.0 - 13 er7 <br /> Mailing Address: ii 35— ,,toe— Uf ' 1) 0' ,, ZIP: 6-5-375',6 <br /> Email and/or Fax: ny(1t I•S t-j il`1 mcu , <br /> ENGINEER INFORMATION: <br /> Name: c iii 4, k- "eels 0I . A..,e1,,,s,�,.a <br /> Phone: ,t ? (f 7 <br /> Address: Q3v S k.1-,' f <br /> ,,{t" City: =t Lva y,Z' ZIP: 4 /Email: vti LcJ S�i r /P. icC. ,'),Fax: ..F <br /> PROJECT INFORMATION: "" �1 E /Z'L(y1 cT 1 ,f�O / <br /> 1. Pool/ Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> t),4) X 44 feet <br /> 2. Heated? yes 0 no54 Single Family 0 Above ground 0 yes 0 no Height * <br /> 3. Excavated materials will be: 0 Multiple Family/Condo �In round *A building permit is required <br /> 0 removed from site for any wall 4-feet or greater in <br /> -used on site ❑ Public 0 Other(specify) height measured from the <br /> 0 Other: (specify) 0 Commercial bottom of the footing to the top <br /> C2 Total Cubic Yards 0 Industrial of the wall, even if it replaces <br /> 6. Sewage Disposal& an existing wall. <br /> ***Any earth movement may require ❑ Other:(specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless the are <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer Y <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka,MN 55345 gi Private Sewer of the higher wall. <br /> Phone: 952-471-0590 <br /> 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or. _ DEPrivate Well <br /> Estimated Construction Value $ C)z> <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />