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. RECEIVED <br /> City of Orono AUG �6 2015 <br /> Building Permit ApplicatioalTY OF ORONO <br /> for Swimming Pools and Hot Tubs <br /> ��A, Mailing Address: <br /> f VO PO Box 66 Permit number: <br /> Crystal Bay, MN 55323-0066 Date received: <br /> ,� Street Address: Received by: <br /> y�, G� 2750 Kelley Parkway Plan review fee: <br /> �qk�,SH���, Orono, MN 55356 <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: 3 37,� �,��-��� (�,�1 � <br /> CONTRACTOR/APPLICANT INF�M TION;� I <br /> Name: �i4�-L�u�1-'1 c���,S 1r.�.L � �A �2�5 i� 6��bv l S <br /> State License# Expiration Date: <br /> Phone: !o�/ • �-t�9p. /3 5'9 Fax: G.s%• ygo- 3 � <br /> Address: B �.o� t.c��s!- Cit : �- � ZIP: ��� � <br /> Contact Person: d.�- ContacYs phone num er Liz. ��,�Z�i— <br /> Email: p{t_ p� e ;�.,,�,g.i� „ Applicant is� ontracto Homeowner �a��ie o�e� <br /> PROPERTY OWNER INFORMATION: <br /> Name: .�"�1+�n-�S -�- Sl-}�q�2v� <br /> Phone (day): <br /> Mailing Address: Z�P: <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: Cit • ZIP• <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Poo1J Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> ��-� X `+�'� 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 ❑ Public �\ for any wall 4-feet or greater in <br /> used on site ❑ 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 <br /> MCWD review and permits. Tiered walls are considered <br /> Minnehaha Creek Watershed District(MCWD) ❑ PubliC Sewer One wall UnleSs they 8re <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 />