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City of Orono <br /> Building Permit Application ' <br /> for Swimming Pools and Hot Tubs 757 48 <br /> ��*1:<<,e <br /> Mailing Address: Permit number: 2-0i (, —c07 0/ <br /> PO Box 66 <br /> M* Crystal Bay, MN 55323-0066 Date received: C'/17// 1 <br /> tipA61Street Address: I ,....,00eyed by: �1' 2750 Kelley Parkwa /O I Plan review fee: 5� ----W, 7 <br /> Orono, MN 55356 I - <br /> EsHo <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 be submitted. <br /> Incomplete applications will be returned. (Please print) <br /> GENERAL INFORMATION: <br /> Job Site Address: 2C. r'vn c.) O r cANa rck 'a &J \-*----1 Ll <br /> CONTRACTOR/APPLICANT INFORMAII�N:. <br /> Name: 'fieirrh> _ )› C-- <br /> State License# /V-)09. Expiration Date: <br /> Phone: "'&', 3 - ---6E) - / O Fax: <br /> Address: 10 OCS - ' 3F? tav-e1 3O City: P\ ( I6U-& ZIP: 6--- ---3 6,9 <br /> Contact Person: 1114r, ' i , G • IS Contact's phone number 76,3- Syp --c I 0-z,Email: Meir 11 Cc ael A 5 - Si'rtc .60 M Applicant is: QContracto ) Homeowner (Circle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: -beLJ 1'`(-1 c -A ? r1 '-- <br /> Phone (day): ep S I- 5`'2. - 3 Z801 �tbn <br /> Mailing Address: -.-_`-_-3-- erc O .)(�c--hitt- r i !V r 6 ZIP: S5 <br /> Email and/or Fax: AN (GC C re) <br /> -Cone% <br /> ENGINEER INFORMATION: dbeneGticl- - @, g t <br /> ryn <br /> Name: <br /> Phone: <br /> Address: City: ZIP: <br /> Email: Fax: <br /> PROJECT INFORMATION: STN -- C)/0:ia lc- Co / <br /> 1. Pool/ Hot Tub Di ensjons: 4.Accessory to: 5.Type: 7. Retaining Walls? <br /> 1-c' ' X feet <br /> 2. Heated? 01 yes El noSingle Family ❑Above ground 0 yes o Height * <br /> 3. Excavated materials will be: Multiple Family/Condo (IIn-ground *A building permit is required <br /> ❑ removed from site for any wall 4-feet or greater in <br /> 0 Public <br /> used on site 0 Other(specify) height measured from the <br /> Other: (specify) C:1 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 ❑ 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 /> 15320 Minnetonka Blvd separated by twice the height <br /> Minnetonka, MN 55345 Private Sewer of the higher wall. <br /> Phone: 952-471-0590 0 Public Water <br /> Fax: 952-471-0682 <br /> www.minnehahacreek.orq Ki'Private Well <br /> Estimated Construction Value $ 7/ o_ `=`' <br /> Packet Last Updated: April 2016 <br /> Page 22 <br />