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City of Orono <br /> Building Permit Application <br /> for Swimming Pools and Hot Tubs <br /> Mailing Address: <br /> "V..0./\/„.‘ PO Box 66 Permit number: 2G/`(� /(2 ?� <br /> Crystal Bay, MN 55323-0066 Date received: C1 / 5-7/ <br /> Street Address: _ Received by: 2 .5 . <br /> y`se L 4. 2750 Kelley Parkw. ��.�( 071(..--1 (o PI n review fee: g-- <br /> �kESHO�� Orono, MN 55356 fI`� •� - '�/` <br /> otal 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 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: <br /> 1 /3 gO , /?,e7-)r Z/V <br /> CONTRACTOR/APPL ANT INFORMAT N: <br /> Name: i2 7766: z, i S <br /> State License# Expiration Date: <br /> Phone: ' - 3"-' Fax: <br /> Address: 8 7 cv,--1 j�ir City: ,©,l z ZIP: ss--/f `7 <br /> Contact Person: AiT�;E2ar�' Contact's phone number �/Z- 1T- -/Z3j— <br /> Email: p A -.-, �S ciy�im�7i,,4ic a e a pplicant is: ontract Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: 4,,, c- &e._Aiiee (gzi-Ah4) <br /> Phone(day): /1,,2_ !la,—Ao —4:13-y <br /> Mailing Address: ZIP: <br /> Email and/or Fax: leA (")e440ret, (, 61 6:711,4_,L : ems` <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool/ t Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> /� r�X .1(o feet <br /> 2. Heated? tgf yes 0 no ''Single Family 0 Above ground 0 yes g(no Height * <br /> 3. Excavated materials will be: 0 Multiple Family/Condo `_In-ground *A building permit is required <br /> ❑ removed from site <br /> ❑ Public for any wall 4-feet or greater in <br /> Igi used on site 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 <br /> MCWD review and permits. <br /> Tiered walls are considered <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer one wall unless they are <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 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq 0 Private Well <br /> Estimated Construction Value $ Z57cCe <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />