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• City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> -$..0A/- Mailing Address: Permit number: 0/4,2 —(.9/-3, <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: / / 2_O/i, j <br /> Street Address: rD <br /> -° I 8 \ L <br /> �� 2750 Kelley Park .Of L' -L 1401 Plan review fee: 3 110. 5?�' Orono, MN 5535 <br /> `li ESHO�� 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: / /e 5 Pl/ieP/ ex-c) / 4 <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: _TR c Foots L .C_. <br /> State License# Expiration Date: <br /> Phone: ,7&j T bg — SF ? Fax: �7b 3 -- (3:4.— c7 5 <br /> Address: /10 , a fuer 4 /t1 Lc., City: g' . ZIP: - , ` <br /> Contact Person: :3j/ Contact's phone I••- <br /> Email: Aft 4)pt - Applicant is: ontractor omeowner (circle one) <br /> PROPERTY OWNER INFORMATION_L -- , <br /> Name: Al acytt .1- ,3e,N jo,4, aiu,r,,5 (- <br /> Phone (day): Gf6a 00 — -73 ej'7 <br /> Mailing Address: it i6t) Uit 4.4, b i' . ZIP: 6-535^ <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: c (tv ,g,,„1 'A:WS 0 I r�v��.. .a <br /> Phone: t <br /> Address: 9 30 --.17, ,-7./. ,� . f rC f- City: rt 1�r y4�, ZIP: 4 1 e cr ci <br /> Email: L(i �c ill S cs r CB C.0, Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool/ Hot Tub Dimensions:/� 4.Accessory to: 5.Type: 7.Retaining Walls? <br /> E,0 X 4,r? feet <br /> 2. Heated? lyes ❑ no ❑Above ground 0 yes ❑ no Height * <br /> 54 Single Family g <br /> 3. Excavated materials will be: <br /> ❑ Multiple Family!Condo ry_In-ground *A building permit is required <br /> ❑ removed from site for any wall 4-feet or greater in <br /> [14-used on site 0 Public <br /> ❑ Other(specify) height measured from the <br /> ❑ Other: (specify) ❑ Commercial bottom of the footing to the top <br /> E240 Total Cubic Yards ❑ Industrial of the wall, even if it replaces <br /> 6. Sewage Disposal & an existing wall. <br /> **''Any earth movement may require 0 Other: (specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless the are <br /> Minnehaha Creek Watershed District(MCWD) El Public Sewer Y <br /> separated by twice the height <br /> 15320 Minnetonka Blvd <br /> g{ Private Sewer of the higher wall. <br /> Minnetonka, MN 55345 9 <br /> Phone: 952-471-0590 <br /> 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.org _ ( Private Well <br /> Estimated Construction Value $ 3 r79,(S 647 <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />