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x' '}-__3 <br /> 3c/ City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> 0:0:Y Mailing Address: Permit number: o2O/ g as 4- <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 3 -' D -( g <br /> Street Address: Received by: — <br /> ti 111 L 2750 Kelley Parkway Plan review fee: <br /> `� Orono, MN 55356 <br /> `itEsH00" 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: /3 / �VG/j!l2 4'i DI,'4 , dwd>✓d <br /> CONTRACTOR I APPLICANT 5�� TI JjI <br /> Name: D C <br /> 11 <br /> State License# Expiration Date: <br /> Phone: /lja'lak ♦J;D Fax: �,5 <br /> Address: 0 D 31-( City // (,eI✓/i ZIP: 'S S-U 1d <br /> Contact Person: /'11 'E -/Ethey Contact's phon <br /> Email: 4 S 0 /04,t god .0 a ( Applicant is: Contractor Homeowner (Circle one) <br /> 549 pr . ev "I <br /> PROPERTY OWNER INFORMATION <br /> Name: Mak e 13 <br /> fi/73l /3t1'd id <br /> Phone (day): 6/j — ?1tv-- GG <br /> Mailing Address: /, y �U?7// ,dd hi ,OK $ ZIP: S's'34. ( <br /> Email and/or Fax: X114)A/ /--idyy//i./ 3/ 3yet, 6' hJ 1Q/( . CO 14-1 <br /> ENGINEER INFORMATION; <br /> Name: <br /> Phone: <br /> Address: City:: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1.POO i Hqt Tub Dim nsions: 4.Accessory to: 5.Type: 7.Retaining Walls? <br /> 2-0 X (�� feet <br /> 2. Heated? es 0 no Single Family 0 Above ground 0 yes ( io Height <br /> 3. Excavated materials will be: 0 Multiple Family/Condo ,ln-ground *A building permit is required <br /> 0 removed from site for any wall 4-feet or greater In <br /> used on site ❑Public <br /> 0 Other(specify) height measured from the <br /> Other:(specify) /a) 0 Commercial bottom of the footing to the top <br /> J/ ) 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 0 Other:(specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) U-Public Sewer separated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 <br /> 14'Priblic Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.oro 0 Private Well <br /> Estimated Construction Value $ z/deO)' <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />