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� <br /> . .�► <br /> . <br /> ► <br /> � ��O City of Orono FOR CITY USE ONLY <br /> � � N P.O. Box 66 Q Date Received: 1 L- Permit# L�� — y � <br /> � 2750 Kelley Parkway /1' <br /> C rystal Ba y,MN 55323 ��� A m o u n t: $ S A C C r e d i t:--"i-�1 g <br /> I (952)249-4600 �j <br /> 'a �- ' �� Homeowner(s)Signed: ❑Yes���� �� g� /� <br /> ,� r <br /> yF � � Resolutions(if any)Signed:❑Yes ❑None Required <br /> �-9,��SH���� Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> � <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: //G� � ��a-� �v'� <br /> �—� f �� - s n1 P�S <br /> Owner. ���S A-rv � ►�►rv�.v� Mailing Address: 'l l�D G�-�-�1 q'�`e � <br /> City: l J1�a�Yl O Zip: S�� l D <br /> Phone: l D� ? . (J7C7 • tj(�� Email: SJs.�.h�a-mw.,, �. ��w�c.�t-• no-'�'" <br /> Contractor/Applicant Information: <br /> �, �' L�► S-�Yt.�-t�� <br /> Contractor/App.: i � Contact Person: <br /> Address: �c�U � . \0.,�S"I • State License#: �� [Q���`�� <br /> City: �p �S Zip: �`t�/ � Expiration Date: 2 20/�'� <br /> Phone: ��� . �B�P• �(P�-" Email: 1'' C� �Q�n"Q-S � �-G .Cam�' <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 24-48 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 [�Fieavy Equipment ❑ Other �� <br /> � �K) �J.� ��� �Ul�y f�C�-4 V`l'f� �ICfiI'�`-'� <br /> Permit(s) Issued: � Sewer Disconnection �ell�rtran�ianTP�� �� ��,���( �,� �( l <br /> ��..,�n/?�� <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. �l� <br /> Form last Updated: July 2015 �� <br /> 150784 <br />