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� . . , � ��3 59� r2. <br /> ,� i � <br /> • City of Orono �� <br /> Building Permit Application � � ��� <br /> for a Swimming Pool <br /> O Mailing Address: Permit number: / —�v <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: `e27`� <br /> Street Address: Received by: <br /> y � 2750 Kelley Parkway Pian review fee: � . <br /> �,� Orono, MN 55356 � _�'j�� <br /> Ft�'rESH�� Total Fee: �� � <br /> Main: 952-249�1600 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 /> � � /���lrLl S C'�"t� .0 <br /> Job Site Address: So i �p/��S i <br /> CONTRACTOR/APP}�CANT INFOR�ATIQN: �' ��2 .��O " ' Z�J� <br /> Name: Y2�%/b aolS <br /> State License# Expirati Date: <br /> Phone: G�/•�yo- /35'9 Fax: 6 S/• o• ��! <br /> Address: a,J,n. o� uJtS'- Cit :� ,¢v ZIP: S� <br /> Contact Person: ContacYs phone number <br /> Email: �. A licant is: ontracto Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: J�b �' �'t��n1�'n <br /> Phone (day): � • o • o� <br /> Mailing Address: �OS /�2 fi � Z�P: SJ 3 <br /> Email and/or Fax: . �a� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZI P: <br /> Email: 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 /> yes ❑ no � for any wall over 4 feet in <br /> � ❑ Public <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 8� an existing wall. <br /> [�used on site ❑ Other: (specify) Water Supply Tiered walls are considered <br /> �Public Sewer one wall unless they are <br /> ❑ Other: (specify) 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 $ D,Doc'� <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />