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�----�.<� <br /> . <br /> City of Orono <br /> Buildir�g Permit Application <br /> _-__ <br /> for a Svvimm ing Pooi <br /> � '��N� Mailing Address: �� C�b D-7� <br /> O PO Box 66 Permit number. <br /> Crystal Bay, MN 55323-0066 Date received: � / (� � <br /> � , ` Received b <br /> Street Address: Y <br /> ; ,� i .� 2750 Kelley Parkway �f�f ( <br /> ,,!.��� ;��,` Orono, MN 55356 `^'� � �an review fee: . Z�� C1C� <br /> ,�i� <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 appfications wil) be returned. (Please prinf) <br /> GENERAL INFORMATtON: <br /> JobSiteAddress: z(oss �oun�'�ySi�c. ��i✓e- 1.�Q3� � ��onv � MN SS3S'(o <br /> CONTRACTOR 1 LtCANT INFO ON: , , ' ` <br /> Name: ���'��y�1n(K�����iDk- �� MS�1� <br /> State License# � Expiration Date: <br /> Phone: G Fax: 1-$3 2 <br /> Address: C� : <br /> Z ZIP: <br /> Contact Person: � � .,r Contact's phone number � �j <br /> Email: A licant i ontractor omeowner {Circle One) <br /> PROPERTY OWNER INFORMATION: ' I <br /> Name: 1�'lic,haC� o►nd ��a'�'►'UeCn Vosj'?^ <br /> Phone(day): 2 - p <br /> Mailing Address: o �+ 'd c, 0 ri�t W prp rto M ZIP: (o <br /> Email and/or Fax: m VOSSP/1 nA q r'► M�22 CoM <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: <br /> Email: City: ZIP� <br /> Fax: <br /> PROJECT INFORMATION: �Q� �� -- �j�Ll.� <br /> 1. Pool Dimensions: 4.Accessory to: 5. Poot Type: 7. Retaining Walls? <br /> Z� X�_feet �Single Famify ❑Above ground [�yes ❑ no Height� <br /> 2. Heated? ❑ Muitiple Family/Condo � In-ground /A building permit is required <br /> �yes ❑ no � Public for any wall over 4 feet in <br /> ❑Other{specify) height measured from the <br /> 3. Excavated materials will be: ❑ Commercia! bottom of the footing to the top <br /> ❑ Industrial of the wall: even if it replaces <br /> ❑ removed from site 6. Sewage Disposal& an existing wall. <br /> �used on site ❑Other: (specify) Water Supply Tiered wa11s are considered <br /> Other: (specffy) ❑Public Sewer one wall unless they are <br /> separated by twice the height <br /> �Private Sewer of the higher wall. <br /> Total Cubic Yards � Public Water <br /> Private Wel <br /> Estimated Construction Value $ ���,('� <br /> Packet Lasi Updafed: 03/29/13 <br /> Page J9 of 21 <br />