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RECEIVED <br /> City of Orono MAR 2 y 2018 <br /> Building Permit Application <br /> for Swimming Pools and Hot TubsclTMOFORONO <br /> ��1 VO Mailing Address: Permit number: �` O "�3 35 <br /> PO Box 66 q <br /> Crystal Bay, MN 55323-0066 Date received: 3-A2,--t <br /> Street Address: Received by: -ypp� G <br /> ti� L 2750 Kelley Parkwa �I 41 Plan review fee: ,f 3 ft. `p <br /> te'�Fsrto�� Orono, MN 55356 'i ir <br /> 1� <br /> Total Fee: k / a� 00K.,Main: 952-249-4600 Fax: 952-249-4616 www.ci.orono.mn.us 1p , <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: ;-.3 q r Ohl/11'V /a/1/ )‹ <br /> CONTRACTOR/APPLICANT INFORMATION: <br /> Name: is iye,.) &i)c <br /> State License# Expiration Date: <br /> Phone: , 1 lriro. Fax: 4.)- !o S Lf <br /> Address: i __3:1! City:/f//f/ix./i t ZIP: '2z <br /> ) <br /> Contact Person: /0'/6' XE F4.,/ Contact's pho - -- bS' , ' /f It I <br /> Email: Applicant is: Contractor Homeowner (circle one) <br /> PROPERTY OWNER INFORMATION: I <br /> Name: A / 1O/61f1, <br /> Phone (day): 6/2 t 4 f.74/T <br /> Mailing Address: p23lj ollibi lid/ ,e€ l>.�1 thud it),A., ZIP: S 3 i-4., <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool( jot Tub Dim sign$: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> 6' 0 feet <br /> 2. Heated? dyes 0 no Single Family 0 Above ground 0 yes no Height * <br /> 3. Excavated materials will be: ❑ Multiple Family/Condo n-ground *A buildingpermit isrequired <br /> 0 removed from site req <br /> ❑ Public for any wall 4-feet or greater in <br /> El on site Other(specify) height measured from the <br /> ›Cused <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. �Q one wall unless theyare <br /> Minnehaha Creek Watershed District(MCWD) /""Public Sewer <br /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka,MN 55345 0 Private Sewer of the higher wall. <br /> Phone: 952-471-0590 , Public Water RECEIVED <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq 0 Privat Well <br /> Estimated Construction Value $ rrfo'( d MAR 21 2018 <br /> Packet Last Updated: April 2016 <br /> Page 22 CITY OF ORONO <br />