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> . <br /> ',� ��..�Ct-Ol�' `��ry°�-1 <br /> > <br /> � T1 ��c'� C�.:� ��--� ,� <br /> City of Orono ��,5� <br /> . . . ��v <br /> Bu�lding Perm�t Appl�cation <br /> for Swimming Pools and Hot Tubs <br /> �O , ` Mailing Address: PeRnit number: ��7 "t1C:- 1 �� <br /> l��O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 2 --"�j�/ � <br /> '�'1�� _ �G� Received by: �'�_� <br /> Street Address: _� (�, <br /> y�, G� 2750 Kelley Parkw C ' �� FF"f(an review fee: �� �'"� <br /> �, Orono, MN 55356 � �� ' � <br /> l9kES H�� <br /> o 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: ��� ��-r��j.,�RL�`�v� <br /> CONTRACTOR PLICANT INFO�ATION: <br /> Name: -� h- �� <br /> State License# ' > � - � Expiration Date: <br /> Phone: (c51 C Fax: �(�,}'7,31� �'� �Z- <br /> Address: c- Cit : ZIP: <br /> Contact Person: _l,- ContacYs phone numbe /��-S��-����,�ca,c�T. <br /> Email: �,L,I�„r�, L5�2 �t�(`�y�(��T� �'� Applicant is:�ti��'� � Homeowner (Circle One) <br /> PROPERTY OWNER NFORMATION: <br /> Name: �j-� — � � �~"" � <br /> Phone (day): � � � , �� <br /> Mailing Address: f�-� ' �, � ZIP: `j <br /> Email and/or Fax: � � <br /> 1 � � � �g <br /> ENGINEER INFORMATION: � <br /> Name: �/ � <br /> Phone: <br /> Address: ,� r�� � ZIP: <br /> EmaiL- �� V� <br /> P CT INFORMATION: `I�,'� 1 <br /> .Pool/`H Tub Dimensions: 4.Accesso► �,��� �g Walls? <br /> X -y 2� feet �/,� i i� <br /> 2.Heated? yes ❑ no [�Single Fam tJ no Heigh� �� ' <br /> 3. Excavated materials will be: ❑Mulfiple Farr, 'A buildin <br /> g permit is required <br /> �removed from site for any wall 4-feet or greater in <br /> used on site ❑Public .,,�r(specify) height measured from the <br /> ❑ Other:(specify) ❑Commercial bottom of the footing to the top <br /> Total Cubic Yards of the wall, even if it replaces <br /> ❑Industrial 6.Sewage Disposal 8 an existing wall. <br /> "*"Any earth movement may require ❑Other: (specify) Water Supply Tie�ed walls are considered <br /> MCWD review and permits. pPublic Sewer �e wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) Y' separated 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: 952-471-0682 <br /> www.minnehahacreek.or ❑P�vate Well <br /> Estimated Construction Value S �-�j;���,� <br /> Packet Last Updated: Apri12016 <br /> Page 22 <br />