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� � /57g� . City of Orono , � D`� Build�n Permit A lication �� 9 pp for a Swimming Pool �O�O Mailing Address: Permit number: a.OI3" � PO Box 66 Crystai Bay, MN 55323-0066 Date received: � , Q - Street Address: Received by: y � 2750 Kelley Parkway Plan review fee: t� ✓� • 3l0 `�tq ��,�' Orono, MN 55356 �013- �� kFSHo Total Fee: Main: 952-249-4600 Fax: 952-249-4616 ��;;�r, c� o�o�� mn us This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: z��(� �p,��-�-�Sf��f t' - � � _ CONTRACTOR I APPLI INFORMAT N: Name: C��i� c�� G.S �� . State License# ��, ��T�pExpiration Date: Phone: Fax: Address: s�;� Cit : ZIP: '- � Contact Person: ContacYs phone numb r Email: ,�� f �,,�/s.�'�,�..�,Applicant is: Contractor Homeownerr (Circle0ne) PROPERTY OWNER INFORMATION: � Name: o✓ Phone (day): � Mailing Address: � ,�, ZIP: Email and/or Fax: ENGINEER INFORMATION: Name: Phone: Add ress: City: ZI P: Email: �ax: PROJECT INFORMATION: 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? v^P/ � X c��feet ❑Above ground �yes ❑ no Heightf-' ❑ Single Family 2. Heated? ❑ Multiple Family/Condo �n-ground �A building permit is required ,�yes ❑ no � Public for any wall over 4 feet in � ❑ Other(specify) height measured from the 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top ❑ Industrial of the wall, even if it replaces �removed from site 6.Sewage Disposal & an existing wall. �used on site ❑ Other: (specify) Water Supply Tiered walls are considered ❑ Other: (specify) ❑ Public Sewer one wall unless they are separated by twice the height �Private Sewer of the higher wall. Total Cubic Yards ❑ Public Water ❑ Private Well Estimated Construction Value $ �! ,�0� Packet Last Updated: 03/29/13 Page 19 of 21