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Crity of Orono q��1� le <br /> Building Permit Appfication <br /> for a Swimming Pool ,�a73°� <br /> Mailing Address: Permit number: 0-����Z- <br /> �,�. PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � lD <br /> 0 �.��, 0 , � <br /> a ���'�S�y �, Sfreet Address: Received by: <br /> ��. `��si�� �ti <br /> \,�,L���`��' 2750 Kelley Parkway Plan reviewfee: /72. S� c?0/0-00 /( rQct <br /> \kEsxo�`'�/ Orono, MN 55356 <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 /> fncomplete appfications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ri � �� � <br /> _ � I � �-e�nc�c�.� �� , , <br /> CONTRACTOR/ARI�LICANT INFORMAT <br /> Name: .�S -�z� �.�.-��C'x.�� � <br /> State License# � ;�- Expiration Date: �' ( <br /> Phone: 3- 5 � Fax: ,Z - " � — � � � <br /> Add�2SS: � �� �" " F �✓ �, � ��I Clty: � �v�� ZIP: , <br /> Contact Person: '� c��.tiv�c:� ContacYs phone n.umb�r_ <br /> Email r - - '� �-}�►n �,o �,v�°p�icant is: �Contractor Homeowner (CircleOne) <br /> PROPERTY OWNE INF RMAT ON: <br /> N a m e: �-;, �--'v���r <br /> Phone (day): <br /> Mailing Address: �� �-��r i1 C�. '� '� • ZIP: C�C`�_�-� b <br /> Email and/or Fax <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 3.Accessory to: 4. Pool Type: 5. Sewage Disposal & <br /> ❑Above ground Water Supply <br /> ��Single Family <br /> � �-. �,��'`�� i n-ground ❑ Public Sewer <br /> , � X ✓� feet ❑ Multiple Family/Condo <br /> ❑ Public ❑ Other(specify) ❑ Private Sewer <br /> 2.Heated? ❑ Pubfic Water <br /> ❑ Commercial Excavated materiais will be: <br /> ��es ❑ Industrial •�� <br /> removed from site ❑ Private Well <br /> ❑ no ❑ Other: (specify) <br /> ❑ used on site <br /> ❑ Other: (specify) <br /> � �. <br /> Estimated Construction Valuation � �r ��--J <br /> Last Updated: 9/1/2010 <br /> - 7 - <br />