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2-q-)3 <br /> C,L_ 4(') <br /> O City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received-_p Permit#p;1�13-0O 56 <br /> 0 ,2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> ' Homeowner(s)Signed: ❑Yes <br /> yF L� Resolutions(if any)Signed: None Required <br /> lgKES H O�� ZoningDisclosure Si one Required <br /> Y <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: X Residential �-�❑ Commercial J <br /> Site Address: 760 / 5Nk4 H/� �D L�N� 141 � � 5535 <br /> Owner: NANCY ,0"So t1) Mailing Address: 5RM18r 10V55' <br /> City: // Zip: <br /> Phone: b1Zq• $� ' /76 7 Email: N4wle-y 0► /'t e- MdD1?6M• Cor" <br /> Contractor/Applicant Information: <br /> Contractor/App.: CyXJW <br /> tCo• Contact Person: /P <br /> Address: / 7Z S �,xC�-$I eqt, gwp State License#: Z Y 7 3 <br /> City: Sr• L&VIs eA�� Zip: Expiration Date: 3 31//C/ <br /> Phone: !SZ - V�o5' .35 8 Z Email: 1540ysf .SCh&xt Vn,Gowpi#w16 S, tom <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 discontiriued at the City service by qualified contractor before demo permit is <br /> issued. <br /> Demolition by means of: ❑ Manual Disassembly A Heavy Equipment ❑ Other <br /> Permit(s) Issued: X 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 Ar sketch showing all structures on the property. Note which <br /> structures are to be demolished. <br /> /2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Site Runoff Control. <br /> /3. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the MCWD or <br /> documentation stating permit(s)are not required. 413 <br /> .2_� ! <br />