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Sf <br /> CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT <br /> P.O. Box 66 (2750 Kelley Parkway) <br /> Crystal Bay, MN 55323 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e. well abandonmment, etc. <br /> 2. Work must not begin unless the permit 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: qA 5 onyc,( Ave� <br /> Occupancy Type: _Residential Commercial <br /> OWNER'S NAME: MOA u 5 m cem-� Phone: 9SdL16 q— <br /> Mailing Address: d;?5 7C/1 k& +,,U City: L YD/I0, P? <br /> CONTRACTOR'S NAME: 'j D t� Bus.No.: 7&31g7q— ) 79 7 <br /> Mailing Address:QL10 Jtcr,�. 1 a 1� City: AY /e- Nam <br /> ►'1 <br /> Demolition if planned by means of: manual disassembly <br /> heavy equipment <br /> Permits Issued: n 16L,- Well Wil remain 1 rl u s e� <br /> # Well Abandonment <br /> In return for issuance of said Demolition Permit,the undersigned owner hereby agrees as follows: <br /> 1. 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 off adjoining 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 />