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DocuSign Envelope ID:20128BC6-0784-4E3A-BCEC-625DCFF04752 4. Submit a$2,500 escrow and an escrow agreement signed by the property owner(copy attached). 5. Keep all structure(s)enclosed and/or secured until such time as demolition is complete. 6. Keep all demolition debris off adjoining property and/or the public rights-of way unless specific prior approval is obtained in writing for temporary use thereof. 7. Completely remove foundation(s) from the ground. 8. Completely dispose of all demolition debris off site in accordance with all applicable PCA requirements. 9. Abandon water wells in accordance with State Health Department regulations. 10. Call for an inspection when all debris has been removed, before backfilling. 11. Within 5 working days of superstructure removal, a final inspection shall be requested. The site shall be left clean and clear of all debris, with any excavation filled with earth level with the adjacent ground elevation (except when such excavation is to be used as part of a new building and such new building is actually under construction). 12. Abandon septic systems per Minnesota Rules Chapter 7080. All septic tanks must be pumped, crushed and filled with native soils. An inspection is required after the tanks are pumped and before the tanks are crushed and filled. 13. The undersigned owner shall and hereby does indemnify and hold harmless the City of Orono, its agents, employees and assigns from and against all claims, damages, losses or expenses, including attorney fees, against the City, its agents, employees and assigns arising out of or resulting from the demolition described herein as performed by the property owner, his employees, agents, subcontractors or assigns. PERMIT TYPE AND FEE CALCULATION n $75.00 - Principal Structure $ 75.00 garage )(f $50.00 -Accessory Structure x 1 (how many) 50.00 1. Subtotal of above permit requested $ 125.00 2. State Surcharge 1.00 3. TOTAL PERMIT FEE (add lines 1-2 above) $ 126.00 The undersigned herby applies to the City of Orono for issuance of a Demolition Permit, agrees to do all the work in a strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are complete, true and correct. Applicant's Signature: � sr Date: Lf fa [ci Doc igned by: Owner's Signature: P ; Date: 4/10/2018 —7520A6:. : 465... . . 4- r 5(/8 Approved By: � Date: Wing 0 ficial) *Zoning Disclosure Required? YES ENO *This must be filled out by Zoning Depay�m nt-�Foreither answer, a Zoning Official must sign all applications. *Approved By: AI -II;w WAllti Date: 5.3. 1 (Zoning Official) Form Last Updated. July 2015 150784