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,A � l <br /> L N� -----_ <br /> , � � l ���w , / <br /> � !i <br /> �� � �� � � �� <br /> lp C�ty of Orono � �� <br /> Building Permit Application <br /> for a Swimming Pool <br /> O Mailing Address: Permit number: O�/.�"� <br /> � �O PO Box 66 � / �2 <br /> Crystal Bay, MN 55323-0066 Date received: �0—`7'—/� <br /> Street Address: Received by: <br /> y� G� 2750 Kelley Parkway Plan review fee: <br /> Orono, MN 55356 <br /> t�'�ESHO�� 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: �� � ���, � �Q � 2� �P <br /> CONTRACTOR/APP�,.1�J ANT INFORMATtQN: <br /> Name: �r� il a�/(F ����./��/ <br /> State License# Expiration Date: <br /> Phone: [ ' � f Fax: <br /> Address: � /� Cit : � � l � ; ZIP: ,� <br /> Contact Person: ' � � 1 � �(l ContacYs phone number <br /> Email: App�icant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFO TION: <br /> Name: ,�t�G�.,�Fl��' L����G�L� <br /> Phone (day): <br /> Mailing Address: L/�-C.� �L 6' l� ZIP: �� 3�j <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: n C�)� � V�U - ��V 7 <br /> ,� <br /> Name: � �• /v G <br /> Phone: �r`�- ' C <br /> Address: � �i f Cit : � � ZIP: _.�'J'��/ <br /> EmaiL ��- _ ,i� n C�ri � �1 S N :E-t..S'`^�- Fax: �= <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> �_X�feet �Single Family ❑Above ground ❑ yes '�no Height " <br /> 2. Heated? ❑ Multiple Family/Condo �In-ground "A building permit is required <br /> '�j yes ❑ no � Public for any wall over 4 feet in <br /> ❑ Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑ Commercial 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 walls are considered <br /> ❑ Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> [�Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> ❑ Public Water <br /> � Priv We <br /> Estimated Construction Value $ �� <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />