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City of Orono <br /> Building Permit Application <br /> for a Swimming Pool <br /> O Mailing Address: Permit number: /�j-� <br /> PO Box 66 <br /> � � Crystal Bay, MN 55323-0066 Date received: ���" � <br /> � Street Address: `3 Received by: <br /> y ��' 2750 Kelley Parkway (2'�� Plan review fee: <br /> `� � Orono, MN 55356 � <br /> ��KFSHo�`�` Total Fee: � 7��'� �� <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: '� � ��- ,�,4 �� � /1� �`� �B,q G� <br /> CONTRACTOR/APPLcICANT INFORMATION:, <br /> Name: hl R � �a o�r <br /> State License# N/A Expiration Date: <br /> Phone: '7�,� � �O,�,�- �3 (F 3 Fax: � - 6d a� � 6 <br /> Address: t ld Cr o •+� Ci : ZIP: �0 3r <br /> Contact Person: ER� �_�A� GE-�v ContacYs phone num <br /> Email: A licant is: ractor Homeowner (Circle One) <br /> PROPERTY OWNER INF�RMATION: <br /> Name: u,r�f `� �i� � �c�n,,' cQ <br /> Phone (day): � <br /> Mailing Address: o .S' ` � Z�P� <br /> Email and/or Fax: ry� „ 4 � <br /> ENGINEER INFORMATION: <br /> Name: c.v o . <br /> Phone: <br /> Address: ' Ci : .�,r ZIP: �/ (o 0 <br /> Email: Fax: �� <br /> PROJECT 1NFORMATION: _ <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> l�J X '��feet (�Single Family ❑Above ground ❑yes �no Height " <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 materiats 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 8� an existing wall. <br /> �used on site ❑Other: (specify) Water Supply Tiered walls are considered <br /> ❑Other: s eci ) ❑ Public Sewer one wall unless they are <br /> � p � separated by twice the height <br /> � [1�,Private Sewer of the higher wall. <br /> �� Total Cubic Yards ❑Public Water <br /> Private Well <br /> Estimated Construction Value $ � Q pp O � <br /> -� <br /> Packet Last Updated: 03/29/13 <br />