Laserfiche WebLink
� � • R���li/�� <br /> City of Orono 0C1" 2 4 2a16 <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs CINOFORONO <br /> �O� Mailing Address: Permit number: p� `(O-� s <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: � -b <br /> Streef Address: Received by: �L <br /> y�, G� 2750 Kelley Parkway Plan review fee: �j � <br /> t�kESH�4`� Orono, MN 55356 o?Ol(o- (� ! � � <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 wwv��.ci.orono_mn.us 1� <br /> This application form must be completed in full and all required information ust e subm�t d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��� � <br /> � C,�����.�� �� <br /> CONTRACTOR/�2P�ICANT INFORMATIO� <br /> Name: ``C:���,�- s 'C_� C��'d- �.'�" <br /> State License# � � �-� . y; Expiration Date: <br /> Phone: ( '• 'i - c, Z► Fax: �j `7 'L- <br /> Address: L �, ��-L.�; , Cit :` • w�+ ZIP:�. <br /> Contact Person: �,��— ContacYs phone num (• � �, <br /> EmaiL a. !���;h�=� ' � � �� licant is tracto Homeowner (Circle One) <br /> PROPERTY OWN�t INFORMATION: <br /> Name: ( �E'�'�?�:! �C"E'_?�-,'�" �-1:�5�".� <br /> Phone (day): ( � � , ,� 3 � �i <br /> Mailing Address: �_�'��" r,���-����-� �•�� ZIP: -��"S� � <br /> Email and/or Fax: �..I�Q iS;'�' � i, . �� , �� , , ,� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PR ECT INFORMATION: <br /> 1. ool Hot Tub Dime ons: 4.Accessory to: 5.Type: 7. Retaining Walls? i <br /> ��X =3� feet <br /> 2. Heated? yes ❑ no ❑Above ground � yes ❑ no Heigh�� J * <br /> �-'Single Family <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo �In-ground *A building permit is required <br /> �emoved from site for any wall 4-feet or greater in <br /> used on site ❑ Public ❑ Other(specify) height measured from the <br /> ❑ Other: (specify) ❑ Commercial bottom of the footing to the top <br /> Total Cubic Yards of the wall, even if it replaces <br /> ❑ Industrial 6. Sewage Disposal& an existing wall. <br /> ***Any earth movement may require ❑ Other: (specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. � Public Sewer one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) separated by twiCe the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 f� rP+�—{��� <br /> Fax: 952-471-0682 ❑ Public Water `s � � <br /> www.minnehahacreek.or ❑ Private Well <br /> Estimated Construction Value $ ��,L� <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />