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CITY OF ORONC 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: / T,� L-JA 1 <br /> Occupancy Type: Residential Commercial <br /> OWNER'S NAME: ufm -vkv,4(4�y ZI U4 A, Phone: 447&-!20U— <br /> mailing <br /> 7&- 0U <br /> Mailing Address: R J kk LrEbF-7- z City: WAgUTA <br /> CONTRACTOR'S NAME: y +JT � QJk.^W4% (' us.No.: <br /> Mailing Address: : , - • N I Ii-, City: c.a FTO L-0 <br /> Demolition if planned by means of: manual disassembly <br /> ! _heavy equipment <br /> Permits Issued: <br /> # Well Abandonment C�Fes- J'r`IGLDSf..Op&-wT- APP) <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 />