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City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> �� Mailing Address: Permit number: c=3:10/ i Oo <br /> PO Box 66 <br /> ±,\• <br /> l ' Crystal Bay, MN 55323-0066 fp Date received: /--/ 0—/ <br /> �i� �� ?) Received by: ,i,„4- <br /> ..t4 <br /> 1/4� Street Address: <br /> N t,►�+1�1‘' 2750 Kelley Parkwa Plan review fee: O " <br /> 0sH� �G ` Orono, MN 55356 030` a_boO ,�[2.- <br /> Total Fee: o <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: Z�Z 5 /C E!z y ,6t0, c,r2a 4co <br /> CONTRACTOR/APPLICgNT INF,RMAT,IQN: <br /> Name: . 1J4-41, odl5 <br /> State License# Expiration Date: <br /> Phone: y5Z 9115 11.E y Fax: <br /> Address: Co35 a C.�da.!1 , 6 i/. / City: /4../4 .—am ZIP: 5—<-0*yy1 <br /> Contact Person: ►2� 1( , 'Z- Contact's phone number 'llZ - Yl/ .-399 <br /> Email: /' Ct) ria,,,-x, /ye/, "c/eApplicant is: Contractor Homeowner (circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: AQ.v,(e y <br /> Phone(day): <br /> Mailing Address: Z4 25 iee// ..,4t/, ZIP: <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1.Po / Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> 09 X 2.- feet <br /> 2. Heated? ayes 0 no Single Family 0 Above ground 0 yes 0 no Height * <br /> 3. Excavated materials will be: 0 Multiple Family/Condo [ tom round *A building permit is required <br /> ❑ removed from site for any wall 4-feet or greater in <br /> Ei used on site ❑ Public <br /> 0 Other(specify) height measured from the <br /> ❑Other:(specify) 0 Commercial bottom of the footing to the top <br /> Total Cubic Yards ❑ Industrial of the wall, even if it replaces <br /> 6. Sewage Disposal& an existing wall. <br /> ***Any earth movement may require 0 Other:(specify) Water Supply Tiered walls are considered <br /> MCWD review and permits. one wall unless theyare <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer <br /> separated by twice the height <br /> 15320 Minnetonka Blvd <br /> Minnetonka,MN 55345 0 Private Sewer of the higher wall. <br /> Phone: 952-471-0590 <br /> 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq 0 Private Well RECEIVED <br /> Estimated Construction Value $ /.3 r•-(-1") <br /> Packet Last Updated: April2016 JAN 1 6 7018 <br /> Page 22 <br /> CITY OF ORONO <br />