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� . . . ��. 5� �� �%f�- <br /> �� . <br /> �� �w <br /> �, <br /> j�'�� � P.O. BoOx 66O(2O7 OK elley Pazkway) �PLICATION FOR DEMOLITION PERMIT <br /> Crystal Bay, NIN 55323 <br /> ' SPECIAL CONDITIONS & HOLD HARMI�ESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other pernuts, i.e. well abandonmment, etc. <br /> 2. Work must not begin unless the pernut card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call(612) 249-4600. <br /> JOB SITE ADDRESS: �; ��_ �"� l( n <br /> 5 S�r��, a-� � I�� <br /> Occupancy Type: � Residential �� Commercial <br /> OWNER'SNAME: l ,� � �, -v��y :%F�'; Phone: <br /> Mailing Address: City: <br /> CONTRACTOR'SNAME: ���f'����1 �Kv�L���rh� �� Bus.No.: ys :-'-y7,3 :y3s <br /> Mailing Address:/`�� �5%' 1'j'l���e�o.uK� P L��Q City: GvE,�2�,�a_ <br /> Demolition if planned by means of: manual disassembly <br /> :�l heavy equipment <br /> Pernuts Iss�aed: <br /> # Well Abandonment <br /> In return for issuance of said Demolition Permit,the undersigned owner hereby agrees as follows: <br /> l. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> complete. <br /> 2. Demolition debris will be kept offadjoining property and/or the public rights-of-way unless <br /> specific prior approval is obtained in writing for temporary use thereof. <br /> 3. Foundations shall be completely removed from the ground. <br /> 4. All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health Department regulations. <br /> 6. Inspection required when all debris has been removed, before backfilling. <br />