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� � . �z�{v <br /> � city of Orono ,�5 <br /> Building Permit Application �� ( , <br /> for a Swimmin P 1 � <br /> g o0 <br /> ! A'`.� Mailing Address: Permit number. �d��'' �� <br /> �O,V�\�, C sBtal Ba , MN 55323-0066 Date received: � � '/ <br /> rY Y �S � <br /> � 1 Received by: <br /> r � � ;�� Street Address: <br /> yF �; 2750 Kelley Parkway Plan review fee: d 0/�— �D�Z <br /> � `� ' Orono, MN 55356 <br /> ��kfstio`��/ �D3 39 <br /> _..__.� Total F e: <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 informa ion must be subm d. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: ,�,"�"� ������F� ��v� <br /> CONTRACTOR/ LICANT INFORMAT ON: �� <br /> Name: � <br /> State License# � Expiration Date: <br /> Phone: �. Zj Fax: ��5� � � � <br /> Address: Cit : r3 ZIP: �''�' � <br /> Contact Person: �- r a -r. ContacYs phone numbe (�E 5' �)"�75^ ��'�d' <br /> Email: ��.;,��;��j,,��J �, ��yv�L/� j,��- Applicant is: ontractor/ fiomeowner (CircleOne) <br /> PROPERTY OWNER INFORN�pTION: � <br /> Name: ��,°� �--t�fiT � t�v'�L�,,�1�J <br /> Phone (day): <br /> Mailing Address: ����i�y"�,f�2 t1 Sa-jOkC` �e.-��� (�,�C� /�� ZIPS���, <br /> Email and/or Fax: <br /> ENGINEER INFORM TION: <br /> Name: �K. C � (�._"r':5 <br /> Phone: �, — <br /> Address: Ci : ZIP� ` <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7.Retaining Walls? <br /> ��_X��feet ❑Above ground [�yes ❑ no Height� l' <br /> '� Single Family <br /> 2. Heated? ❑ Multiple Family/Condo [� In-ground "A building permit is required <br /> �yes ❑ no � public for any wall over 4 feet in <br /> ❑ Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑ Commercial bottom of the footing to the top <br /> ❑ Industrial of the wall, even if it replaces <br /> ❑ removed from site 6.Sewage Disposal& an existing wall. <br /> �used on site ❑ Other: (specify) Water Supply <br /> Tiered walls are considered <br /> ❑ Other: (specify) �Public Sewer one wall unless they are <br /> separated by twice the height <br /> ❑ Private Sewer of the higher wall. <br /> Total Cubic Yards <br /> ❑ Public Water <br /> ❑ Private Well - <br /> Estimated Construction Value $ � <br /> Packet Last Updated: 0329/13 <br /> Page 19 of 21 <br />