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City of Orono c�. <br /> l� <br /> Building Permit Application � <br /> for Swimming Pools and Hot Tubs <br /> ��� Mai��PO Bo��66� �' ����'� �� Permit number. (��7���J�1� �� <br /> 0 Crystal Bay, MN 55323-0066 Date received: �S"'���1 V'a e.�/11G� '� <br /> Street Address: Received by: <br /> y� � 2750 Kelley Parkway Plan review fee: �((/l ���} <br /> G Orono, MN 55356 <br /> `�kFSHo�`` G�'d� 7-�g�� <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: 1669 North Farm Road <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: on behalf of Peterson Pools&Spas Inc <br /> State License# Expiration Date: <br /> PI1011@: 952-933-3010 Fax: <br /> ACjdf@SS: 13110 Excelsior Blvd �.Ity: Minnetonka Z�P: 55343 <br /> Contact Person: Jeremy Peterson ContacYs phone number 612-221-3595 <br /> ECT181I: jpeterson@petersonpools.com Applicant is: on rac or Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: Beenders Antoinette&Monti <br /> Phone (day): <br /> Mailing Address: 1669 North Farm Road 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. Pool/ Hot Tub Dimensions: 4.Accessory to: 5. Type: 7. Retaining Walls? <br /> �2 X 28 feet <br /> 2. Heated? ❑ yes ❑ no �Single Family ❑Above ground ❑ yes �7(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 separated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka, MN 553a5 ❑ 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 $ $22,993.00 <br /> Packet Last Updated.� Apri12016 <br /> Page 22 <br />