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May, 2. 2016 4: 32PM No, 13�� P. 1 <br /> .�--�.. <br /> City of Orono <br /> s�. Q� a,o.eox es . .. : �c.�. i�r�s�oN�,xao�(o-. /— 9 <br /> Q 2�50 Kelley Rarkway naic RoFa1��_�cplii�.'�—�-.. ��/ / <br /> Crystal BaY,MN 55329 `_ � . / <br /> (s�2�249•46ov Amaunr..: .:$ ' SAC CrcAl�: � C� <br /> �� --��.: ,�..� <br /> � � ��J HomcoWn.F!'(s)Siglied: :,_,�J Yos -��..--...�. / � <br /> !,p . �G Tt,as�(utions(ifany)Sagned:�J Ycs ❑Nonc Itcqu;red.,, �%i <br /> ��Sl�i(�� �Zonin nleclusu�nSl nod� Yati HoncRc �ilred <br /> ClTY OF ORON4 - I�EIVIOLITION PERMI7 <br /> (Alf parmlts must be approv�d by Ihe Buildinp Officfal and/or�oning Deparlrnent) <br /> �yL.`�.�� � ���/��w�I.������� ���, S ��jy�-���. <br /> ��� y��.. �..r...i.:. ...�� ���4.r�„�'t�C."lr(��:�,� <br /> TYP�� �Residentlal (� Gommercial I <br /> Site Address; �7. �, pp '�.� <br /> Owner: ,h � �� s� Mailing Address: �M�.� „_ _ � <br /> Cify: ��� �tp� �.�°�..� _ <br /> Phon�: � �2'� ��L�( �mail: \��. �•�����cr 4+1!`c;,�rCd� <br /> " •-- <br /> �i�` .��. ,v _. -!• � .�� <br /> :hi o:'3�e':r a,.,... �x �: . <br /> I_.� u <br /> Cpntractor/App.: � rw �� C-�a � Contact Person: y F G I � � ��'"7 c�e <br /> Address: ���� ���'�u � State Lfcense#: �(���?��? <br /> Gi1y� �� ��''` ��p��S ( �xpiration Date: <br /> Phone� f a�- y `� 55�l' � �mail: �e t`�'�cc,,.,f�,.,,r,r ` <br /> , ���. �. � <br /> .4�. _ .� � ,+"eL ,J.'- ��a. .f.. � ���S� a,[P ..f.ar.1 ..an}.,! J-1 t��Vi�l��xG.t'x`�;`� <br /> 2. c.,:i:� �l <br /> General Instructlons: <br /> 1. You may be required fo obtain olher permlrs,i.e.:weN abandonment, sewer,efc. <br /> 2, Wark must nol beg►n unless the permi!card is available on ilie jab slt�. <br /> 3 A 2a�48 hour notice Is roqulred for�II Inspections. Call(952)2q9-4600. � <br /> 4. Sewer must be dls�ontinued at the Clty service by qu�lified contractor before demo permil is issu�d. <br /> DemoliEion by means of: [�Manual Disassembly �Heavy �quipment []Other <br /> Permi!(s)(ssucad: �]Se�,ver C7iscannection ��Well Abandonrt1enl# <br /> In r�turn for lssuan�e of said bemolltlorl Permlt,the undersigned owner hereby agreas to: <br /> 'I, Submlt a survey, aerlal photo or sketch siiowing All structures on lt�e property. Note whfch strucluros are <br /> to be demolished. <br /> 2, Submit a survey, aerlal photo or skefch showing proposed eroslon contro! measures in accordence with <br /> Chapter 79, Construcllon Slte Runoff Con(rol. <br /> 3. Submlt a copy oi permil spproval from the Minnehaha Creek Watershed District (MGWD). The Clfy wlll <br /> not issue a demolltion permll wifhout a copy of llie p�rmlt(s) irom the MCWD or documantatlon staling I <br /> permlt(s)are no�required. <br /> Form Las!Updared: July 2015 I <br /> 15076q <br /> I <br /> � <br /> I <br />