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l 7 �t� <br /> . c �,`� <br /> City of Orono <br /> Building Permit Application �� <br /> for a Swimmin Pool `�� <br /> 9 <br /> O�\ Mai1iP0 Bo�r66 � Permit number: �10I -DO.� S <br /> y_ �\\� Crystal Bay, MN 55323-0066 Date received: ' '� � <br /> 0 .�� �, <br /> �u:�>.�_ �� <br /> �,� ��� �, Street Address: Received by: S <br /> �' ���'�`�� �ti � 2750 Kelley Parkway Plan review fee: o2Dl � -Ol7$��{ <br /> L�v'��� M1'lug� Orono, MN 55356 <br /> kESH� / �� (�` <br /> Total Fee: •J <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 /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: /,j pp �2�� �,2�F�� �2,J� <br /> CONTRACTOR/AP�LICANT INFORMATION: <br /> Name: f:��5�bf �ir��S <br /> State License # Expiration Date: <br /> Phone: �s/-�90•/�9 f Fax: 6�i•/pO•3�/ <br /> Address: 8� �� i�,9,0 �si Cit : .� � ZIP: ss�i <br /> Contact Person: ContacYs phon�� <br /> Email �p�,�� s � oT�rA�� . c�+'� Applicant is: Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> N a m e: �-�i� �4f-�L �, �{,Q�L �ls� +�1tL_l �--- <br /> Phone (day): ,?. 723-��G � T T <br /> Mailing Address: /�x� y����s,� ��.� i� , ZIP: 553`i/ <br /> Email and/or Fax �j Q���_�� <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: Cit : ZIP: <br /> Email Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 6. Sewage Disposal 8� <br /> �B X �� feet WaterSupply <br /> �Single Family ❑ Above ground <br /> ❑ Public Sewer <br /> 2. Heated? ❑ Multiple Family/Condo � In-ground <br /> �yes ❑ no ❑ Public (,�Private Sewer <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> (,�] removed from site ❑ Industrial 6. Retaining Walls? �Private Well <br /> ❑ used on site ❑ Other: (specify) <br /> ❑ yes [� no <br /> ❑ Other: (specify) <br /> Height <br /> Total Cubic Yards <br /> Estimated Construction Valuation $ �5 ��� � <br /> Last Updated: 10/28/2010 <br /> - 7 - <br />