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�OA lO City of Orono R ITY USE ONLY �7 <br /> �y P.O.Box 66 Date Received� Pcrmit# �� " / <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ ��� SAC Credit: <br /> (952)249-4600 <br /> a <br /> �' Homeowner(s)Signed: ❑Yes <br /> �E' �,� Resolutions(if any)Signed:❑Yes ❑None Required <br /> 17KES H��� Zoning Disclosure Signed: ❑Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: <br /> Type: �Residential ❑ Commercial <br /> Site Address: _ 2y�0 C�I d Q eac►� ►�o0.a <br /> Jos�Ph s�,..'µ;,,���-; <br /> Owner: A�� Abouelc„��„ Mailing Address: Zy20 dld �jca�� �oaa <br /> City: �✓�o�o Zip: SS-39� <br /> Phone:_ (n12 - 8yS- 3889 EmaiL ar�N. Abo�ci�.�c��@4c��rlis.cow, <br /> � <br /> Contractor/ pplicant Information: <br /> Contractor/App.: Cro�doh ��a�+�s Contact Persorr. Jcf��•Y '�tio��Oso� <br /> Address: S�lS9 �''1a;., 5+�. Su:f� �L00 State License#: �C S3I `i(vI <br /> City: A �a,,, Zip: 5535 9 Expiration Date: <br /> Phone: qSL - 215� Z�(o3 Email: ic�crty @ 9o✓-do� - ;ar�cJ. c�� <br /> � <br /> SPECIAL CONDITIONS & 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) Issu d: ❑ Sewer Disconnectio ❑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 �`, '3'� <br /> 150784 <br />