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� <br /> t 1 <br /> � � l <br /> Cit of Orono �'J <br /> Y � �� <br /> Bu�lding Permit Application � <br /> for a Swimming Pool <br /> ���^ , MailiPO Bo r66 � Permit number. ��� � -C'C ��C� <br /> ,VrJ \ Crystal Bay, MN 55323-006� � Date received: c1J ,/ (.9 S <br /> _ 1 ^� StreetAddress: Received by: � <br /> � � 2750 Keile Parkwa ? 'J "( <br /> % : Y Y �,���^� lan review fee: • Z 3 ��tL � <br /> ,, ,�. <br /> Orona MN 55356 <br /> ,�f , ,,,, � <br /> � Totai Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 - j �x�,t p,p p�-�,��� V I <br /> This application form must be completed in full and all required information must submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> JobSiteAddress: z(o �s �oun�'�ySi��- ��i✓t- WQ3'� � 0(o�u � MN SS3S'(o <br /> CONTRACTOR f LICANT INFO ON: <br /> Name: �f����cs�j �4�- � ,�t"`.J� <br /> State License# � � —' Expiration Date: <br /> Phone: � Fax: ' �-$j� Z <br /> Address: Ci : � � ZiP: <br /> Contact Person: � Contact's phone number _� -• �' U <br /> Email: �� � A Gcant i ontractor �, omeowner (Circte One) <br /> PROPERTY OWNER IfVFORMATION: <br /> Name: 1�'lic.l�G.e.l An� ��a't'�eCn Vots?i1 <br /> Phone (day): 2 - Z p <br /> Mailing Address: o „-F 'd c. Ori�t. We..�' prp►1,0 �+'� ZfP: (o <br /> Email andlor Fax: m VUSSQ/1(u� q M Me.22, Co,v� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: CC�I {� � ��ll������ <br /> 1. Pool Dimensions: i 4.Accessory to: I 5. Pool Type: 7. Retaining Wal(s? <br /> ' �� X�feet � ❑Above ground Q�yes ❑ no Height��� <br /> � ��Single Family � � <br /> � � <br /> 2. Heated? ❑ Multiple Family/Condo In-ground "A building permit is required <br /> 1� for any wall over 4 feet in <br /> � �yes ❑ no � Public I ❑ Other(specify) � height measured from the <br /> �3. Excavated materials will be: ❑ Commercial � bottom of the footing to the top <br /> � I ❑ Industrial � � of the wali; even if ii replaces <br /> � ❑ removed from site i , 6. Sewage Disposal 8� � an existing wa!!. <br /> � I ❑ Other: (specify} I Water Supply <br /> 1 �used on site � , I Tiered walls are ccnsidered � <br /> � Other: lspecify) I � ❑ Pubfic Sewer one wall unless they are � <br /> I separated by twice the height <br /> � i �Private Sewer � of the higher wall. <br /> Total Cubic Yards , � � Public Water I � <br /> � � Private'Ne1 i � <br /> Estimated Construction Value $ 15�� <br /> Packet Last iJpdated: 03/29/13 <br /> Page 19 of 21 <br />