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City of Orono <br /> Building Permit Application • il, <br /> for Swimming Pools and Hot Tubs ernto <br /> �O A r Mailing Address: Permit number: c)(5/7.0.97 2 / <br /> *11(1")- <br /> VPO Box 66 <br /> Crystal Bay, MN 55323-0066 Date received: 3--/ —�? <br /> Street Address: Received by: /1 <br /> 1/AIV7C'4% <br /> 2750 Kelley Parkway Plan review fee: /�'/, oL <br /> Orono, MN55356Rx201 -O.0 <br /> Total 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 besubmitted. <br /> Incomplete applications will be returned. (Please print) ¢w 7/9 0/ <br /> GENERAL INFORMATION: <br /> Job Site Address: 4325 14iWV -; <br /> CONTRACTOR/ LICANT INFORMATION: <br /> Name: =A..C Iz-/ii4 -`-i' —4--SPAt <br /> State License# QxItt I L:N/ Expiration Date: <br /> Phone: (Ci51} ""1 -3ggD Fax: (65613i—�3 72- <br /> Address: 4.1 - ,,', 5 IJvNc> City:-R_LiAv�" ;.t 13 ZIP:5. <br /> Contact Person: ., ti _ Contact's phone number I) 77 5-39-46 <br /> Email: Applicant is: Contractor Homeowner (Circle One) <br /> PROPERTY OWNER INFORM TION: <br /> Name: MAsi?-< P xS <br /> Phone (day): ORO ($c -2_05 <br /> Mailing Address: 43, 5 LAK-V1 re`4J C.T. Mon'ic /J\K ZIP:553 <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pgpl 5 Hot Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> L Ls' 1 feet <br /> 2. Heated? p yes ❑ no [A Single Family ❑Above ground 0 yes ( no Height <br /> 3. Excavated materials will be: 0 Multiple Family/Condo p In-ground *A building permit is required <br /> 91 removed from site for any wall 4-feet or greater in <br /> used on site ❑ Public 0 Other(specify) height measured from the <br /> ❑Other: (specify) 0 Commercial bottom of the footing to the top <br /> Total Cubic Yards 0 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 they are <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer <br /> separated by twice the height <br /> 15320 Minnetonka Blvd X Private Sewer of the higher wall. <br /> Minnetonka,MN 55345 <br /> Phone: 952-471-0590 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq 0 Private Well <br /> Estimated Construction Value $ 1,5/067C) C-9- <br /> Packet <br /> -=Packet Last Updated: April 2016 <br /> Page 22 <br />