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�--```Y-`�'� City of Orono RECEIVED <br /> /�� �� F K TY USE ONLY z <br /> ��y P.O. Box 66 Date Received���� Permit# �� `� ✓� <br /> �fr �-.� 2750 Kelley Parkway I'�t � �ry�� �,) <br /> Crystal Bay, MN 55323�UI`1 � � Amount: $ r�" SAC Credit: <br /> i (952)249-4600 <br /> i � � <br /> �,,�" � Homeowner(s)Signed: ❑Yes <br /> �'ti�� ! � CITY OF ORONO <br /> t,.. � Resolutions(if any}Signed:�Yes ❑None Required <br /> �ti����`��11�-� `Lonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> �.��'u�'• <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Qwner Information: <br /> Type: [�d] Residential ❑ Commercial <br /> Site Address: I�SO 'Qr��cs-J <br /> Owner: _'��,,;L- ��,1w�.�.L Mailing Address: N526 �w�.N fir•.:l S <br /> City: M.c�►�� Zip: Ss3�Ic <br /> Phone: Email: '�1. �0�-��1-�1 M�). c�^^ <br /> Contra+ctcar 1 Applicant Informatian: <br /> Contractor/App.: S�I�e,.�,w.�1 � i►.� Contact Person: �S�M.cw�t . �� <br /> Address: i53 1,.,n,� 5-� � State License#: 'i�t 5q�t'315 <br /> City: �--iz-•t..� Zip: 553^� Expiration Date: 3��� <br /> Phone: L�2- ��'t-- ���o Email: Sv� (bl 5fio^cw��• ��-�- <br /> SPECIAL CCINDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions: <br /> 1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc. <br /> 2. Work must not begin unless the permit card is available on the job site. <br /> 3. A 24-48 hour notice is required for all inspections. Call (952)249-4600. <br /> 4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued. <br /> Demolition by means of: ❑ Manual Disassembly � Heavy Equipment ❑ Other <br /> Permit(s) Issued: �Sewer Disconnection ❑ Well Abandonment# <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to: <br /> 1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which structures are <br /> to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in accordance with <br /> Chapter 79, Construction Site Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will <br /> not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating <br /> permit(s) are not required. <br /> Form Last Updated: July 2015 I� " ui� <br /> 150784 � <br />