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t � <br /> � City of Orono - I� � <br /> Buildin Permit A lication �I `�� <br /> � <br /> J p p ..� <br /> � for a Swimming Pool <br /> O Mailing Address: Permit number: �J�� � � <br /> �- �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: '�-!D-/� <br /> Street Address: Received by: �T <br /> � � 2750 Kelley Parkway Plan review fee: <br /> ���� � g8/� <br /> t,� ��,�' Orono, MN 55356 d���_p��3� �`L <br /> KESH� <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. (P/ease print) � � ��� <br /> GENERAL INFORMATION: /��� <br /> Job Site Address: �jc` �y�� �.' <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: i�,. , i �,r�c -� �,a11 �:e.�c <br /> State License# ��-���ySa Expiration Date: 3 �-3i-- �,$' <br /> Phone: •763-��-9CY`..ty Fax: �� �,-T��-`'�c�i� <br /> Address: �i Cit : i�k �rt�.,�if ZIP: ' � <br /> Contact Person: �uit� av<„� Contact's phone number '�E,,3-;3t.v-��c�3 <br /> EmaiL �a��i��;�r p � �.; �,��1�Ct^�� CCSV�L�\ - Applicant is: Contractor Homeowner �c���ie o�e� <br /> � <br /> PROPERTY OWNER INF9RMATION: <br /> Name: ��,ds,�,�,� <br /> Phone (day): l�/�_ ;�:x./- �r6��� <br /> Mailing Address: r7 �c�. ZIP: -` - y-� <br /> Email and/or Fax: Y� t�" •Y R•C. Y'v � <br /> ENGINEER INFORMATION: .JU(I C.I�i1��YtQ��' P�'ti�- C.Q��'�1 <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 /> �O X �v 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 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 /> �sed on site ❑ Other: (specify) Water Supply Tiered walls are considered <br /> ❑ Other: (specify) ❑ Public Sewer one wall unless they are <br /> separated by twice the height <br /> ❑ Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> ❑ Public Water <br /> ❑ Private Well <br /> Estimated Construction Value $ <br /> Last Updated: 3/1/2013 <br /> -7 - <br />