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'� � <br /> City of Orono <br /> Buiiding Permit Appiication <br /> for a Swimming Pool <br /> ' O � Mailing Address: Permit number. — ��/ <br /> �� � �/�� PO Box 66 <br /> , Crystal Bay, MN 55323-0066 Date received: �� -�— �5� <br /> , � Street Address: Received by: <br /> % :r 2750 Kelley Parkway Plan review fee: ��%• D <br /> ������a ��� Orono, MN 55356 �������/ <br /> \,kEsfio�` 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 mu e submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: �i�� <br /> Job Site Address: C�r� �C.���� �� ��V'E <br /> CONTRACTOR/�LICANT INFORMATION: <br /> Name: E.�fi�+.,n��LC- Z cac.` •�--`^J�-�4- <br /> State License# ti` I Expiration Date: <br /> Phone: (�_S�1 "�75''3q' G Fax. (��.�i " : i� - 2. <br /> Address: Z �; � r Cit ': ZIP:j.5 � <br /> Contact Person: s � _- Contact's phone number �� 1 S rG G <br /> Email: Y�„Q,-�h� 2 tS- C��'o.�.c.rrs t �� App�icant is� ontracto , Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: � �-S <br /> Phone (day): r"$ - � r " <br /> Mailing Address: � • v MN 55 �' �" - ZIP: <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: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> �X ,� Fj �,. <br /> �=_feet Single Family ❑Above ground �yes ❑ no HeighY� <br /> 2. Heated? � Multiple Family/Condo � In-ground 'A building permit is required <br /> �yes ❑ no � Public for any wall over 4 feet in <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 & an existing wall. <br /> ❑ Other: (specify) Water Supply <br /> ❑ used on site Tiered walls are considered <br /> ❑ Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> 2� � Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> � Public Water • <br /> ❑ Private Well <br /> Estimated Construction Value $ � <br /> Packet Last Updated: 0329/13 <br /> Page 19 of 21 <br /> � <br />