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. ' " � <br /> \ <br /> City of Orono � <br /> � <br /> Building Permit Application � <br /> for Swimming Pools and Hot Tubs <br /> MailingAddress Permitnumber O�('llol� � <br /> ���0 PO Box 66 _ <br /> Crystal Bay, MN 55323-0066 Date received: �� <br /> i ' + � RecQived by: _ <br /> Street Address: / <br /> :� � � 2750 Kelley Parkway �J/ Plan review fee: Cv� , J�' <br /> ��� �� . �" '� Orono, MN 55356 <<� _�.,� � � <br /> �"t t ti��`' J <br /> _, <br /> Main: 952-249-4600 Fax 952-249-4616 cl orona 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: � L 'j�; �;-��;`�;��;, � }-l)�i� R�i A(] <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: � t �?���,7�'.' � � S�-°CrA'TE� <br /> State License# X�" ''� .;L� Expiration Date: 3 3l (p <br /> Phone: c� . �= t Fax: g'S1.. � . ' 7 <br /> Address: r� i2 � •�� ,� 4. -� Cit : ? ZIP: � �.3 � <br /> Contact Person: k F� e�► � ContacYs phone number �2 �j(,r �� '� <br /> Email: �� ��- ` �"' Z • , C c licant is: �ontractoT-� Homeowner (Circle One) <br /> �_ ___— <br /> PROPERTY OWNER NFORMATION: <br /> Name: ^�,�A� � �7rt �NC�2 aJA �� j ��u <br /> Phone (day): �c"� . �-� r� - <br /> Mailing Address: ��y �+ ���L.�. ,f�- N1 , eV ZIP: j��L^ <br /> Email and/or Fax: G,').��Z, C�.�, G•�� �' �,yiA�` . Ca.ti� <br /> ENGINEER INFORMATION: <br /> Name: C�R�-�T�A:� �,c��--t�J�rt'IAorF= _ � �i(:� �TR�--�c.{��- /N�. <br /> Phone: , � , �' - � � <br /> Address: `-f� C1xJxIA�.:..� �fu� 5�� , `a��-rza '�'� City: ��. l�4�,L ZIP: �ja/c� <br /> Email: �t�l ��r�A,vSC ,9���.��5�'Q��c-r��r�.sc Fax: <br /> d y. <br /> PROJECT INFORMATION: <br /> 1. Pool! Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> ��: X �"�Z feet <br /> 2. Heated? yes ❑ no ❑Above ground ❑yes �'ino Height ' <br /> , �Single Family i <br /> 3. Excavated materials will be: ❑ Multiple Family!Condo �In-ground 'A building permit is required ' <br /> ❑ removed from site for any wall 4-feet or greater in i <br /> ; ❑ Public <br /> � used on site ❑ Other(specify) height measured from the � <br /> ❑ Other (specify) ❑ Commercial bottom of the footing to the top ' <br /> Total Cubic Yards ❑ Industrial of the wall, even if it replaces � <br /> 6.Sewage Disposal& an existing wall � <br /> ""Any earth movement may require I ❑ Other (specify) Water Supply <br /> Tiered walls are considered <br /> MCWD review and permits. � ,y one wall unless they are '. <br /> Minnehaha Creek Watershed District(MCWD) � LrJ PubliC Sewef <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka. MN 553a5 ❑ Private Sewer of the higher wall <br /> Phone: 952-471-0590 ❑ Public Water <br /> Fax: 952-471-0682 <br /> 4w✓v�n�innebahacr2eK.or � Pfivate Well <br /> Estimated Construction Value $ ��,�����(` <br /> Packet Last Updafed: August 2015 <br /> Page 22 <br />