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, , <br /> �� � <br /> I � <br /> City of Orono � �- <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> �O . `O Mailing Address: Permit number. ��L'/.S��'�`'_� — <br /> 1�� PO Box 66 <br /> Crystal Bay, MN 55323-006 / Date received: (�-�9_/ s <br /> 1h <br /> � � Street Address: (� � �U' Received by: �� <br /> ti G� 2750 Kelley Parkway V ��' Plan review fee: � t� . $� <br /> `�t �, Orono, MN 55356 �, -. �- , <br /> '�kFSHo� �z.�.C.� /�._.�- Gl/G'S/ <br /> Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � �/L�'(�✓ <br /> This application form must be completed in full and all required inform tion must be sub tted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: �3'7 .S � �'�rz,q�-}�,{,,ti� (��l � �j <br /> CONTRACTOR I APPLICANT IN��MiQTION�� I � <br /> Name: ����_�t�L c;�. 1,�, � �A �2�5 i t !�� l�ov l <br /> State License # Expiration Date: <br /> Phone: �.�/ • Y�10• /3 5'9 Fax: 6�%- 5/go• 3 1 <br /> Address: B C� �,o.� W�.st- Cit : �;� � ZIP: ,.5�, � - <br /> Contact Person: ,�- z ContacYs phone number Giz� 7.1�.�Z.��— <br /> Email: � n�, @ e ;,,,,�,q..r� ,� Applicant is: ontractoJt ._ Homeowner (Circle One) <br /> .�----- <br /> PROPERTY OWNER INFORMATION: <br /> Name: J�+�-�S k- S-��.v�-� <br /> Phone (day): <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. Poo�Hot Tub Dimensions: 4.Accessory to: 5. Type: 7. Retaining Walls? <br /> � X `f�' feet <br /> 2. Heated? yes ❑ no � Single Family ❑Above ground ❑yes [� no Height " <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo �] In-ground *A building permit is required <br /> removed 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 ❑ Industrial of the wall, even if it replaces <br /> 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. one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) ❑ PubliC Sewer <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka, MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 ❑ PubliC Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or ❑ Private Well <br /> Estimated Construction Value $ 2�o00 <br /> Packet Last Updated: August 2015 <br /> Page 22 <br />