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�" � CI'h/Of�fOf10 FO�t CIZY tiSE O'_�ZY <br /> �����`�, P.O Bax 66 Date fteceived ' � Pernut� _ �� ���` ( �; �'� ; f <br /> �i 2750 Ke#IeyParkway �-J � <br /> ; CrysEal Bay,MN 55323 P,mount: $ SAC Credit: <br /> 4 <br /> � �; � (952}249-460� <br /> �"`.r �� Homeonmer(s)Signe�_ Q Yes <br /> '��sh =,`` Resolutions(ifany}3ignetl ❑`i es Q N�s Reyuir� <br /> �.��ST ��y-�g,�� �j ZouingDisclosurs3rgped �Yes Ql�oneitec�uired � <br /> � . ' _ i <br /> t_ , - �,�� i "�j�t,��;r"i(<� C -. -i - -�� <br /> ., �. . �.._ i <br /> f I l_ Wl C f,e._Y"I�,1 1 t <br /> C[TY OF ORONO - DEMOLfTION PERMlT <br /> {All pertnits must beapproved b�ths Buitding Offiaai andJorZoning Departmenf} <br /> _ . _ . . __ <br /> J�b 5tte f C.�wrter IntOrma��ot1 <br /> Type: �Residential ❑ Commercial <br /> Site Address: ���7C�C- ,��fic�,��- ,}��� �r- <br /> OWCEBt": �1'7,v/1� �.��t-r�.l�_S Mailing Address: i7�>� �«:ro,/'.s+P ���" <br /> CI�/: (�l-�.r� �, Zlp: ..�� `j / <br /> Phone: Email: <br /> �� _.....___...._....__.....................__......_,.......�_..___ <br /> ..._Lor�tractor i 1�p�1�c��t Ir�to�r�twr�: �� <br /> Contractor/App.: �-/,�,��ri,,�r� c,� c' Contact Person: �.�},���� <br /> ��� '�tate License#: C 3 <br /> Add�2SS_ �C'������ �'t�'�- ��.Uf:r'r �t �.���`l�-' � <br /> City: C��;r�w�� Zip: -S3�i/ Expiration Date: 3-3/-- Zo/� <br /> Phone: �f S`f� ? c; � �`�(,. Email:�� /�r�/1 -/ra=��--� . <os�� <br /> �. ...___. ... ..._.. _ _ __. _�. ��..._...�._.� _ � - �'��'/ <br /> �,.. _____�.�._ SPECI�IC CON['}�T�ON�� Ht)L[3 #�A►RMLESS AGR��;��NT ,�///////, <br /> General I nstructions: <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 2448 hour notice is required for all inspections. Call (952}249-4600. <br /> 4. Sewer m usf be discontinued at the Ci#y service by qualified contractor before demo permit is issued. <br /> Demol�ion by means of: ❑ Manual Disassembly �Heavy Equipment ❑ Other � <br /> Permi#(s) Issued: �❑ Sewer aisconnection �� ❑Well Abandonment# i���,� , '� `�`- ,, i�%��� � <br /> � i��. _ " ', �r <br /> In retum for issuance ofi said Demolition Permit, the undersigned owner hereby agrees to: <br /> 1. Submit a survey, aerial photo or sketch showing all strudures on the property. Note which structures are <br /> to be dem�lished. <br /> 2. Submit a survey, aerial photo or ske#ch showing proposed erosion contr-ol measures in accordance with <br /> Chap#er 79, Canstr�.�ction Site Runoff Control. <br /> 3. Submit a copy of permit apprvval from the Minnehaha Creek Watershed District (MCVN�). The City will <br /> not issue a demol�ion permit without a copy of the permit(s) from the MCWD or documentation stating <br /> permit(s)are not required. <br /> Form tast Updafed Jufy 2095 <br /> 1507&3 <br />