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.� <br /> .�► <br /> City of Orono � ci L,sE o:rL�� <br /> �O� P.O. Box 66 ��°'�����"" Date Receivec�: � Permit#�fU�7� � <br /> � 2750 Kelley Parkway � <br /> Crystal Bay, MN 55 � Amount: $ G SAC Credit:�� �� ���� <br /> ��K 13 �U� ;' �� � <br /> (952)249-4600 �� ,J <br /> y ,� Homeowner(s)Signed: ❑Yes ��� ��7� � ��f��I <br /> F G� C�TY OF OROt�O Resolutions(ifany)Signed:❑Yes ❑None Required <br /> t�kESH��� Zonin Disclosure Si ned: ❑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: �7�� S-N�d��9 1'wc�v� �f � Di2O/U o �N ���3 E�� <br /> Owner: �I��T��►v �-�� �.��� S�}�„(�Ilailing Address: 7od l �,Ir-�'STaN l�� <br /> City: h � ��J O�p-�L�. Zip: SS3��� <br /> Phone: � I�-' 3��--� �--7 O Email: Gre-���r , S h�.,.� � are-ui%vy� _ ,`n�, c�,n-� <br /> L y i� • .S �h o��✓� /�re�i r�?M- l�n�. Ce-v�- <br /> Contractor/Applicant Information: � <br /> Contractor/App.: S��N���fl � 1�1� Contact Person: /o��1-Q- ��1�S <br /> Address: �S3 F L 19-I��_ S� State License#: �— s`i�3 � S <br /> City: �YZP�-"�i°�- Zip: �� Expiration Date: <br /> Phone: 6 I�� "�(,� — y�dC) Email: -1'o w.wr�o, S�.-,,�.�v��. ��-c„ <br /> SPE(::IAL CONDITIONS & HOLD H��RMLESS 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 [Qf 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 �� r O�� <br /> 150784 <br />