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� <br /> , - , � ��� � / 9q� <br /> City of Orono <br /> Building Permit Application ��z 5'. z5' <br /> for a Swimming Pool <br /> MailingAddress: Permitnumber: � �'—L%�-�{`y <br /> O�i,�,j�r PO Box 66 <br /> � `-- Z�-1 Z <br /> ' Crystal Bay, MN 55323-0066 Date received: � � I <br /> �� , � <br /> � �k� `:� �, Street Address: _ _ _, _._ Receive�:___ �� �� �(� <br /> �'�n�%���,����„������' 2750 Kelley Parkw�p��Z�p�{�� Plan reviewfee: �(..�� .� ��c �� <br /> �kEB{H04' Orono, MN 55356 _______ _.___�. _ -__ <br /> 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: � •� �� � / � ��s�, �� L�� � <br /> 0'1 <br /> Name:RACTOR/APP�L�S T I�1���ATIC�N�� <br /> --�J � <br /> State License# � Expiration Date: <br /> Phone: — (j �¢3 Fax: (� Z— Gq'8� <br /> Address: f/c�S Lro.(vot ,q�/ aw �' ity: � ZIP: S,S�i �— <br /> Contact Person: ���p y ContacYs phone r <br /> Email ��z��. Applicant is� Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: / <br /> Name: �c:.!(�ro�:a✓ �-�C�c.�n,+� �, t� S�'f C�.L� — �Q�Z --� (O�� '—�� Q 7 <br /> Phone (day): <br /> Mailing Address: � �, �, _�„q � ZIP: .$ <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: ��� t.�� �� �S� D � �a�-7` t�v�►�� -�`j`�b <br /> Phone: � �� <br /> Address: `) ��� -`��S^ ,��c Cit : ': cy ZIP: Ocf <br /> Email ax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal & <br /> Water Supply <br /> X�_feet �Single Family ❑ Above ground <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo �In-ground <br /> [�yes ❑ no [�„Private Sewer <br /> ❑ Public <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> �.removed from site ❑ Industrial 6. Retaining Walls? �Private Well <br /> ❑ used on site ❑ Other: (specify) <br /> �yes �no <br /> ❑ Other: (specify) "� <br /> Height c�'`oC� <br /> ��'�� Total Cubic Yards �,/� (� _ ` S ;�� <br /> Estimated Construction Valuation $ ,.� �� ���� <br /> Last Updated: 10/28I2010 v <br /> - 7 - <br />