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City of Orono � <br /> Building Permit Application <br /> �h ; l�O 9, d 8 <br /> for Swimming Pools and Hot Tubs <br /> /� Mailing Address: ' -;( � <br /> ! ���~ ' PO Box 66 Permit number: �:' '� <br /> Q Crystal Bay, MN 55323-0066 ' Lt � Date received: 'f �: i� ;;L`-'�' � <br /> +` �� - /� <br /> i � Street Address: �' ,` � Received by: G�+' <br /> `` � � ( 2750 Kelle Parkwa � � <br /> ��,� ' � �;� Y Y �� Plan review fee: � �`�. <br /> � tq�� ��Lf` Orono, MN 55356 �� U <br /> s r{� Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 w�,vw.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. (P/ease print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ��y ?-�� ��,(�,,�-�y��yl��� ��� <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: lYILLI.i�YI �C1� ` ' l�l � � (�� YYl i C- �^��S <br /> State License# L � Expiration Date: <br /> Phone: � -�� - '� Fax: C{�7�� -L��S-—1 c�t'i`� <br /> Address: �L� � . _�, Cit :��(l — IP:��`?�1cj <br /> Contact Person: FY ���LcJ•\\ (1 ContacYs phone number �?IS ����-���3���., <br /> ��; <br /> EmaiL Ey�c�,in�,C�,���:��c�l:�. L�� Applicant is:�'Contractor ' Homeowner (Circle One) <br /> �__. __ <br /> PROPERTY OWNER INFORMATION: <br /> H�..�.�,(Z�b��� <br /> Name: , <br /> Phone (day): � c3,— �1 L,Q�-`�L c�, <br /> Mailing Address: ' SY1U � �3'C' , 'Cl� l��`1�'lY-1 ZIP: ��j�c� j <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: I�.e.�nq�r�C'_�'C�c`� <br /> Phone: �� ���� � uC.�l 1 <br /> Address: ��1 1 l:� Q � Cit : iL LC�k�. ZIP:��j uc <br /> Email: iCK� '� �("� �.�f� ° . ' ax: <br /> PROJECT INFORMATION: <br /> 1. Pool/ Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> �5'� X ��L 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 of the wall, even if it replaces <br /> ❑ Industrial 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 <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka, MN 55345 ❑ Private Sewer of the higher wall. <br /> Phone: 952-471-0590 ❑ Public Water <br /> Fax: 952-471-0682 <br /> v�r�v�N.minnehahacreek or �Private Well <br /> Estimated Construction Value $ �� � ,���'��v <br /> Packet Last Updated: April 2016 <br /> Page 22 SEP � 7 7 U�� <br /> CITY OF ORONO <br />