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/ I o' 1) <br /> /' I i 2, <br /> City of Orono' .�� <br /> / Building Permit A i .L tion �'-"�' <br /> for Swimming Pools and Hot Tubs <br /> r Mailing Address: Permit number: <br /> .O1V PO Box 66 � ��' ���(� <br /> O Crystal Bay, MN 55323-0066 Date received: <br /> 7(t)//257/ <br /> /1,'Street Address: Received by: ./ /Z'41'. <br /> y� NA-4' 2750 Kelley Parkes 0 A. n169 ' PI.n review fee: cc) E/ g��' No <br /> `9kESH0�� Orono, MN 55356 .0z �/L <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: $ / 3 go 0/?ern <br /> v Z,V <br /> CONTRACTOR/APPLI ANT INFORMAT N: <br /> Name: 2.16 f e l S <br /> State License# Expiration Date: <br /> Phone: ; -- . '' --i3e* Fax: <br /> Address: ?7 et,,,t n 7 r1J 1 City: a ,, ZIP: -s--/1 `7 <br /> Contact Person: _p,4T-/,/,-fr;,,,et Contact's phone number ,/2- i e -/2.4 s— <br /> Email: /0 fi —'c �✓/v,-?",4/c ,w.tiApplicant is: &tract Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: 4,, Ekc,tile ((1i-i/4-) <br /> Phone (day): ,,--,,,as e/:.—Ao,2—e / <br /> Mailing Address: ZIP: <br /> Email and/or Fax: le Ac....n A-0 j . 6, 6/(, y1r4-i L ; e <br /> ENGINEER INFORMATION: <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool It Tub Dimensions: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> X 34 feet <br /> 2. Heated? Oyes 0 no ''Single Family 0 Above ground 0 yes no Height * <br /> 3. Excavated materials will be: 0 Multiple Family I Condo ''0_In-ground *A building permit is required <br /> 0 removed from sitefor any wall 4-feet or greater in <br /> Egl used on site 0 Public <br /> 0 Other(specify) height measured from the <br /> 0 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 the are <br /> Minnehaha Creek Watershed District(MCWD) 0 Public Sewer y <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 <br /> Estimated Construction Value $ ZS,c x? <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />