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� l 37 S� <br /> '1 R " � � � <br /> , ' Ci of Orono � 5`�� � <br /> . � � <br /> Building Permit Application <br /> for a Swimming Pool <br /> �O ,� - Mailing Address Permit number: � —� <br /> �� PO Box 66 _ <br /> � Crystal Bay, MN 55323-0066 Date received: — <br /> � Street Address: Received by: 7�Yj7- <br /> � a ; <br /> Z � 2750 Kelley Parkway Plan review fee: <br /> `�tq ��L� Orono, MN 55356 Ol r L_ � � � <br /> kest{o � � <br /> ___ Total Fee: <br /> Main: 952-249-4600 Fax: 952-249-4616 www.cf 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: �?S ��--��� � � <br /> CONTRACTOR/APPLICANT IN RMATION: <br /> Name: a E c� '—' <br /> State License# Expirat on Date: <br /> Phone: fol7 Z Z(_ 7,S_� '� Fax: <br /> Address: � �j � �k ,�-��� ��/�/ . City: �c� ZIP: � <br /> Contact Person: �5'�,� _,� ContacYs phone n � _ �— <br /> Email: A licant is: ontractor �� omeowner (Clrcle One) <br /> PROPERTY OWNER INFORMATION: <br /> Name: <br /> Phone (day): Z <br /> Mailing Address: ZIP: ���_ <br /> Email and/or Fax: <br /> ENGINEER INFORMATION: <br /> Name: <br /> r Phone: <br /> Address: City: ZI P: <br /> Email: Fax: <br /> PROJECT INFORMATION: <br /> 1. Pool Dimensions: 4.Accessory to: 5. Pool Type: 7. Retaining Walls? <br /> �� X�feet ❑Above ground ❑yes ❑ no Height ' <br /> ❑ Single Family <br /> 2. Heated? ❑ Multiple Family/Condo �In-ground "A building permit is required <br /> ❑yes ❑ no C � for any wall over 4 feet in <br /> ❑ Public <br /> ❑ Other(specify) height measured from the <br /> 3. Excavated materials will be: ❑Commercial bottom of the footing to the top <br /> ❑ Industrial of the wall, even if it replaces <br /> ❑ removed from site 6.Sewage Disposal 8� an existing wall. <br /> �used on site ❑ Other: (specify) Water Supply <br /> Tiered walls are considered <br /> one wall unless they are <br /> ❑ Other: (specify) ❑ Public Sewer separated by twice the height <br /> ❑ Private Sewer of the higher wall. <br /> ��Total Cubic Yards ❑ Public Water <br /> Private Well <br /> Estimated Construction Value $ 3�, S(�ZS <br /> � <br /> Packet Last Updated: 03/29/13 <br /> Page 19 of 21 <br />