2013-00255 In-ground Pool - Laserfiche WebLink

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f ` ��\� � � . ,�� -� � City of Orono ,1� � � � Buildin Permit A lica io� ' �� 9 pp � �t� , � `c 1 for a Swimming Pool O Mailing Address: Permit number: 020�.3-dbZJ`� � �O PO Box 66 Crystal Bay, MN 55323-0066 Date received: �-�7�.3 Street Address: Received by: � � y ��C'' 2750 Kelley Parkway Plan review fee: � J� F�'�kESH��G Orono, MN 55356 a0i3_� Total Fee: Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us � This application form must be completed in full and all required information must be submitted. Incomplete applications will be returned. (Please print) GENERAL INFORMATION: Job Site Address: s��- � C��`L� �� . CONTRACTOR/APPL CANT INFOR ATI N: Name: �i2�-sTtb� S State License# Expiration Date: Phone: �i/-� Fax: 6r/� yQp• 3i Address: B7 sr' Cit :S � ZIP:S�i Contact Person: � ContacYs phone n Email: — - S n i?vtr41� ��d►�+� A licant is: ontr ctor Homeowner (Circle One) PROPERTY OWNER INFORMATIQ1V: Name: �..r,� J o�� Phone (day): — Mailing Address: a /��'' ! Z�P: S� �' Email and/or Fax: �' Q S . Cv✓►� ENGINEER INFORMATION: � Name: , Phone: .� Address: City: ZIP: Email: Fax: PROJECT INFORMATION: 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? e2U X�feet ❑Above ground ❑yes �no Height " -T� �Single Family 2. Heated? ❑ Multiple Family/Condo �In-ground "A building permit is required yes ❑ no � public for any wall over 4 feet in ❑Other(specify) height measured from the 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top ❑ Industrial of the wall, even if it replaces ❑ removed from site 6.Sewage Disposal 8 an existing wall. �used on site ❑ Other: (specify) Water Supply Tiered walls are considered ❑Other: (specify) ❑ Public Sewer one wall unless they are separated by twice the height �] Private Sewer of the higher wall. Total Cubic Yards ❑ Public Water Private Well Estimated Construction Value $ �,5,�� Packet Last Updated: 03/29/13 Page 19 of 21