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� �7 �Scr-ovJ a��'� <br /> �/'� z7 ��f��.v �a ,d <br /> � City of Orono <br /> Buiiding Permit Application <br /> for Swimming Pools and Hot Tubs <br /> �O� Mailing Address: Permit number. ��7� / <br /> O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date receive8: Z �- /-1 <br /> ,� � St►Bet Address: �J� Reaeived by: ��Z.Z� \ <br /> y�, `� 2750 Kelley Park OC ��y���: � <br /> t,�k�sHo4�, Orono, MN 55356 � ���� <br /> o ee: <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 inf�rmation must be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATI�N: <br /> Job Site Address: ������T1-}��-}d(�C/.�� <br /> CONTRACTOR PLICANT INFO ATION: <br /> Name: �1`1 <br /> State License# � Expiratfon Date: <br /> Phone: 1 � d Fax: (�5� '7 Z, <br /> Address: Cit : ZIP: <br /> Contact Person: U- Contact's phone numbe (��;�-77�,��n <br /> Email: , licant is: � ntra -�lomeowner �ci�a o�� <br /> PROPERTY OWNER NFORMATION: <br /> Name: �I� �- � 51�-- <br /> Phone(day): .. <br /> Mailing Address: Z�p; <br /> Email andbr Fau: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> P CT INFORMATION: <br /> .Pool/ H TXb Di��ons; �t 4.Accessory to; 5.Type: 7.Retaining Walls? � <br /> 1► <br /> 2.Heated? y�ns no �Single Family ❑Above ground '�yes ❑no Heigh� I� * <br /> 3. Excavated maberials will be: ❑Multiple Family/Condo In round 'A buildln <br /> removed from site � '� 9 Pertnit is required <br /> ❑Pubfic for any wall 4feet or greater in <br /> used on site ❑Other(specify) height measured from the <br /> Other:(specity) ❑Commercial bottom of the foofing to the top <br /> Total Cubic Yards ❑Industrial of the wall, even if it replaces <br /> 6.Sewage Disposal8 an existing wall. <br /> **'My earth movement may require ❑��er:(speciTy) Waber Supply <br /> Tiered walls are considered <br /> MCWD revlew and pennits. one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) �Public Sewer �parated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 ❑Private Sewer of the higher wall. <br /> Phone: 952-471-0590 ❑Public Water <br /> Fax: 952-4T1-0682 <br /> www.minneh hacreek.o ❑Private Well <br /> Estimated Construction Value S � <br /> Packet Last Updated: April 2016 <br /> Pagre 22 <br />