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F <br /> � RECEIVED <br /> � City of Orono HNK � � 20» <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs C�TM OF ORONO <br /> O Mailing Address: Pertnit number: �d�7 � <br /> � �O PO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: _� 7��_ <br /> Received by: --..-- ., <br /> Street Address: - -- <br /> y G� 2750 Kelley Parkway Plan review fee: � � <br /> F <br /> t ��, Orono, MN 55356 ,� �j��� <br /> '�k�s H o � To-ta�T�e�-- _..� -- <br /> Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us �-�(p . � � <br /> This application form must be completed in full and all required information must be submitted. ����%�/3/i,� <br /> Incomplete applications will be returned. (Please print) � <br /> GENERAL INFORMATION: <br /> Job Site Address: � � � ����-T� � . ��,�� <br /> _ <br /> CONTRACTOR/ LICANT INFORMA ON: <br /> Name: --3 <br /> State License# _ Expiration Date: <br /> Phone: Fax: <br /> Address: Z � ^ Cit - � ,c.�t} ZIP: <br /> Contact Person: N ContacYs phone num er �I - <br /> Email: <E,� c� � A licant is: ontrac Homeowner (Circle One) <br /> PROPERTY OW R INFORMATION: <br /> Name: 5 ) F� <br /> Phone (day): Z- („ i <br /> Mailing Address: � �- ZIP:" � 4 <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: -1-Y� ���"U�7,�-� �G�-'� <br /> 1. Pool L Hot Tub Dimensions: 4.Accessory to: 5.Type: T.Retaining Walls? <br /> Z.0 X �� feet <br /> 2.Heated? '�yes ❑ no Single Family ❑Above ground ❑yes �]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 <br /> ❑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 Disposal8� an existing wall. <br /> ***Any earth movement may require ❑Other: (specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. Public Sewer one wall unless they are <br /> Minnehaha Creek Watershed District(MCWD) � separated by finrice the height <br /> 15320 Minnetonka Blvd �Private Sewer of the higher wall. <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 ❑ Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.or Private Well <br /> Estimated Construction Value $ �J;�� <br /> Packet Last Updated.• Apri!2016 ��— <br /> Page 22 <br />