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. �� <br /> City of Orono � �� <br /> \ ,�` <br /> Building Permit Application V <br /> for a Swimming Pool <br /> �O�O MailingAddress: Permit number: ��� ��� � <br /> PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 8-�S�� <br /> Street Address: Received by: <br /> y� � 2750 Kelley Parkway Plan review fee: � '� Z.�O p� <br /> ��' Orono, MN 55356 ��� <br /> `qKESH�� - <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 ��v:v�;; c� cr;�_r��n �:� �,� • �r� <br /> This application form must be completed in full and all required information must be submitted. <br /> Incomplete applications will be returned. (Please print) "1 �IR12,�s,A� <br /> GENERAL INFORMATION: N� l•UI,� 0't <br /> Job Site Address: -' �'��"�����'���,��; (J��.��� <br /> c� <br /> CONTRACTOR/APPL ANT INFORMATION: <br /> Name: '';,��c.- /J�' � =iz �.L�' � � /� �! , �.�c <br /> State License# �`��"�.�� c��-.� Expira ion Date: "��-/c/' <br /> Phone: - �/" -� Fax: %(,y ,�/� �:CY>! <br /> Address: c/' c- • c-t l � Cit : -�c � .�/ ZIP: =z—� / <br /> Contact Person: � � - _:; Contact's phon ef'-��"J�,� �� - ��;s <br /> Email: �= _ � ' ,� • • Applicant is: ntractor Homeowner (Circle One) <br /> PROPERTY OWNER I ORMATION: <br /> Name: �L�r�C �-� c �t�t ��/a�is�c� <br /> Phone (day): �/ - - �' I� <br /> Mailing Address: _ - . �G����.,j r/�cr�- ZIP: r�3"�'" -� <br /> Email andbr Fax. + w ( �� ' 1'1/� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZI P: <br /> Email: �ax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> r-�U X �� �' feet �Single Family ❑ Above ground ❑ yes �no Height * <br /> 2. Heated? ❑ Multiple Family/Condo n-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: ❑ 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 /> Private Well <br /> Estimated Construction Value , � <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />