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City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> ��*I'Ne <br /> Mailing Address: Permit number: 'c2/0-0-0,5V 9 <br /> PO Box 66r _Z�_/ /- <br /> Crystal Bay, MN 55323-0066Date received: ✓ SriStreet Address: Receivedby Mey 2750 Kelley ParkwayPlan review fee: 3 /g, •kESHo� Orono, MN 55356 - —00 Sq: <br /> Total Fee: 1-t / <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.0 a5 . <br /> This application form must be completed in full and all required inforrl'ratior-must -- <br /> Incomplete applications will be returned. (Please print) c * Fla (s<cl- <br /> GENERAL INFORMATION: to 115/A0 <br /> Job Site Address: ,›Z,e7e7 112/L Le41J 4// bio <br /> CONTRACTOR/APPLICANT INFOIRMAJION: <br /> Name: 157'/6F /U®p/S <br /> State License# Expiration Date: <br /> Phone: 66-7- V90 /-T1 g Fax: 4 S'/.- y po - 9/19 <br /> Address: B 7 twat r-y 24 a a42 City: isp-- moi ZIP: . h"'i 1 7 <br /> Contact Person: /- ,M, Contact's phone • •••-r G j 2•.7 12 -- /- "J <br /> Email: p <br /> — /0v , s , o rzscs40/c .e.•-Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: A//16 4,2 3-/-174/-/— <br /> Phone (day): 7S-07— ?J -- g '7 <br /> Mailing Address: o�'a9 yPiak1v /1/ ,1? ZIP: <br /> Email and/or Fax: A/s-/-44/4 0 ScJi,Ai ' ,,- <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: -.:* f1 �--7 ,G-CPIc/ 11,07 <br /> 1. Pool/ Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> 2 U X / feet <br /> 2. Heated? yes 0 no [`Single Family 0 Above ground 0 yes Ci4 no Height * <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo [,In-ground *A building permit is required <br /> Rfremoved from site <br /> or any wall 4-feet or greater in <br /> used on site 0 Public <br /> 0 Other(specify) height measured from the <br /> 0 Other: (specify) 0 Commercial bottom of the footing to the top <br /> 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 the are <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer y <br /> separated by twice the height <br /> 15320 Minnetonka Blvd [X Private Sewer of the higher wall. <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 <br /> 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq Nt Private Well , <br /> Estimated Construction Value $ ,factr <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />