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�O�T City of Orono FOR CTI'Y USE ONLY •Z� <br /> �y P.O.Box 66 Date Received: _^�-r�Q Permit k �'i'�r r � <br /> 0 2750 Kelley Parkway ��, <br /> Crystal Bay, MN 55323 Amount: $ S 1 - SAC Credit: � 1 /A <br /> (952)249-4600 �� � � ` `�i <br /> '� ,� Homeowner(s)Signed: ❑Yes }� � <br /> y� �,� Resolutions(if any)Signed:❑Yes ❑None Required <br /> lqK E S H��� Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> '` �y ; � ��.�-3/l(r� <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: esidential ❑ Commercial <br /> �. 1 <br /> Site Address: � `� � r����''�� � � 1��-' , <br /> Ro�t,1'' <br /> Owner: !20 � �� Mailing Address: S°--� <br /> City: U�''�-� � Zip: $S 3`� I <br /> Phone: � L� �--�Z���- -7 7 � � Email: <br /> Contractor/Applicant Information: <br /> � �J� -,�F,� �;c=�`�--- ��N c��;r��•� �.� <br /> Contractor/App.: � c_�-.�..�- Contact Person: ,S'i� <br /> Address: '1 I 6 �ti,�l �.�-- State License#: �'`�U�-( <br /> City: .��=^�7� �����( Zip: � Expiration Date: � r� <br /> Phone: �r Z-���� ' �J�Cl � Email: �`.�'t•� `-I � /t'�°.-�- <br /> la'1 �•Cmm <br /> SPECIAL CONDITIONS 8� HOLD HARMLESS AGREEMENT <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 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 ❑ 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, aeriat 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 /> �A'V�I1�� <br /> Form Last Updated: July 2015 <br /> 150784 " <br />