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�O'V City of Orono FOR CITY USE ONLY <br /> 0 <br /> P.O.Box 66 Date Received:-G Permit#2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $��. SAC Credit: <br /> (952)249-4600 _ /' <br /> Homeowner(s)Signed: ❑Yes <br /> Resolutions(if any)Signed:❑Yes ❑None Required <br /> � <br /> �� Zoning Disclosure Signed: Yes kESHO � ❑ ❑None Required <br /> L-5c rJ <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: IV Residential ❑ Commercial <br /> Site Address: (2L D � a1nY�� nr�� <br /> Owner: 'lj-2 LdA Mailing Address: 6�Dc) I("S � <br /> City: ocon Cp Zip: 5 5, 5(.P <br /> Phone:(t?U • -74-7 • 22(d Email: M LK� . LICU Q.D CI��� , ClSYY� <br /> Contractor/Applicant Information: <br /> Contractor/App.:'[ l0.Y' 11`leSa'Con'tact Person: �r <br /> Address: QOQ 1'1J10-QnA0% Low State License #: k- 21 <br /> City: Zip: _5Sq+7 Expiration Date: . 201 <br /> Phone: Email: 4-� �� Y�6YYV1_S <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:X 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, 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. <br /> Form Last Updated: July 2015 <br /> 150784 <br />