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� ! <br /> City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> Mailing Address: Permit number: �D�o� " '� ; <br /> 0�.,�,�0 PO Box 66 <br /> � <br /> Crystal Bay, MN 55323-0066 Date received: �� —/ �" !�' <br /> a �`�,��-�+' �, ) Street Address: Re ' d b : --.__ ___ <br /> �'�n ���`'` '� y ���' � 2750 Kelley Parkway Plan review fee: <.-� � J 5� `�, <br /> r�kE3H0�'� Orono, MN 55356 _ �pb`,: <br /> 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 must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �,� � ��� ���(��� �Q�/ <br /> CONTRACTOR/APPLICANT INFO�ATION: <br /> Name: �v!>-Z c'��1 '1'tiC�s � �L � <br /> State License# Expiration Date: <br /> Phone: Cj'SZ c���l�(�� Fax: <br /> Address: �35'G1 �.�o�.�� �a� �i��.a/- CitY�l.�/4p i � ZIP: �-s�vy <br /> Contact Person: ,::�;�,,�t, t,�f,s�°Z� ContacYs phone numberC,l1- p�9 ��o�IQ <br /> Email Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: � pQs . <br /> Phone (daY)� .�3Yc� �'r��a,��-r� /,<<f/ � <br /> Mailing Address: 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: 6. Sewage Disposal & <br /> Water Supply <br /> ZC? X �`,/�Q feet �ngle Family ❑ Above ground <br /> 2. Heated? ❑ Public Sewer <br /> �� ❑ Multiple Family/Condo �n-ground <br /> �yes ❑ no ❑ Private Sewer <br /> ❑ Public <br /> ❑ Other(specify) <br /> 3. Excavated materials will be: ❑ Commercial ❑ Public Water <br /> �removed from site ❑ Industrial 6. Retainin Walls? <br /> g ❑ Private Well <br /> L� used on site ❑ Other: (specify) <br /> ❑ yes ❑ no <br /> ❑ Other: (specify) <br /> Height <br /> Total Cubic Yards <br /> Estimated Construction Valuation $ °���av <br /> Last Updated: 10/28/2010 <br /> -7 - <br />