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S,p. 09.2017 03:52 PM WICKENHAUSER EXCAVATING 9524662231 PAGE. 1/ 4 <br /> City of Orono ICOR CITY USE ONLY <br /> �nl P.O.Box 06 Dulc Rc;:6vcd;q.:�-, Perm it# _ I;b J <br /> d 2750 Kelley Parkway r� <br /> Crystal Bay,MN 55323 Amount, 4/ p SAC Credit; <br /> (952)249.4600 <br /> Homoownor(s)Slgnod: Ycy <br /> tRcsolutions(if iuly)Sisncd:©yos ©Nano Roquircd <br /> Zoning DisclosuroSigned: El Yes None R uired <br /> Ey My <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: � Residential ❑ Commercial <br /> Site Address: /o SD fioti ka wg Rd <br /> Owner: Doy�d h l Qr-f Mailing Address: day kl'S 80 y ai /, COM <br /> City: p Zip: <br /> Phone:6/Z' 6 3 66-! 9 Email; <br /> �l�c:o �rn <br /> — Fa � . <br /> Contractor/Applicant m h►ers Information: q <br /> Contractor/App,:1�✓� �fe�►�74Cdhtact Person: <br /> G <br /> Address: 16 3d CO, At/, 4 State license#: <br /> City: e0 n e Zip: J5)�j z 2 Expiration Date: <br /> Phone: 02.- z 70 - 9 71�6 Email: don tO, vw rk e11 k rere1,emo x,rem <br /> SPECIAL CONDITIONS & HOLD HARMLESS Ar" 'ANT <br /> General Instructions: W <br /> 1. You may be required to obtain other permits, i.e.: <br /> 2. Work must not begin unless the permit card Is t rn <br /> 3. A24-48 hour notice is required for all inspections <br /> 4, Sewer must be discontinued at the City service b� `� • iit is issued, <br /> Demolition by means of: ©Manual Disassembly Heap. <br /> Permit(s) Issued: ©Sewer Disconnection ❑Well Aber, •`` _,,,. <br /> o <br /> In return for Issuance of said Demolition Permit,the ur, _.tined 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 Dlstrlct (MCWD). The City will <br /> not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating <br /> parmit(s)are not required. J <br /> Form Last Updated; July 2015 J <br /> 150784 0 v— <br />