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* ✓ ���-�.�;�,� ►4ta^� S i ,�'��� <br /> � � , � ��C�''c��v {�U�,(� <br /> O City of Orono FOR CITY USE ONLY <br /> � �/� P.O. Box 66 Date Received: ��').71 i'? Permit# Zc�J'7��'i;��y <br /> V , 2750 Kelley Parkway � `� <br /> 1 � Crystal Bay,MN 55323 i Amount: $ SAC Credit: .S <br /> (952)249-4600 ���/ <br /> �; �, j i �'c_ � � d.33 <br /> � <br /> 1�` Homeowner(s)Signed: ❑Ye�' �' � <br /> yF L� /� 1e/ Resolutions(if any)Signed:❑Yes ❑None Required '7�`.�� .� <br /> �qk f S H���� �•f� ��G Zonin Disclosure Si ned: ❑Yes ❑None Re uired � <br /> __� ���,� <br /> �C �c � v� dr���_�--`� <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (Ail permits must be approved by the Building O�cial and/or Zoning DepaRment) <br /> Job Site / Owner Information: <br /> Type: [f Residential ❑ Commercial <br /> Site Address: 2 0�1 0 $H D RE�l N E p�2l V� � d le oN 0 , M �t 55 3`� � <br /> Owner: �"1h14-1'�1'A M. �E P�D Mailing Address: 1 lv (Je 1N• 22Nv ST' <br /> City: �t l�(�tE R P o I.15 Zip: S�`�'OS <br /> Phone:�,Q1`L • �-�� • �`� $� Email: Irteat�l v�nGutv��a �tvl� Gow� <br /> Contractor/Applicant Information: <br /> Contractor/App.: C�.S. M�tGtiisLS GbNST. Contact Person: C.�4RY M�1C}lE(.S <br /> Address: �'}l� l3�PcY� . �i. State License#: GIZ b O � `} 5� <br /> c�ty: M P�S. Zip: SS�fD} Expiration Date: IU1Ac(iG!-} 20 I$ <br /> Phone: (Ql2- Zt0 � 22gj(o Email: t G�1C�S �Otl�nau 1. Lb�+n <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�8 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 /> .�--"`�.. <br /> �Permit(s) Issued: Sewer Disconnection ❑Well Abandonment# <br /> � z��s'7�C�,c � I i <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 <br /> 150784 <br />