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f� <br /> City of Orono REGEIVEL) USEONL�P.O.Box 66 <br /> e?_J�rDate Receiv ) Permit# (J t/� <br /> 2750 Kelley Parkway i f nn <br /> Crystal Bay,MN 55323 U Amount: $7�1-tV SAC Credit: <br /> (952)249-4600 <br /> ITY OF ORONO Homeowner(s)Signed: ❑Yes <br /> C <br /> (, Resolutions(if any)Signed:❑Yes ❑None Required <br /> tgKES H alts Zoning Disclosure Signed: 0 Yes 0 None Requued <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (AN permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Type: Residential ❑ Commercial <br /> Site Address: L� S (J(.I Ui3--i" 16!:124 /U. / <br /> Owner: %�!!� d� vt-V/ <r ailing Address: <br /> City: Zip: <br /> fi�o � Zip: <br /> Phone: _)�G r ��� 7��(s� Email: <br /> Contractor/Applicant Information: <br /> Contractor/App.: a 4Contact Person: L � <br /> Address: /1�Y J� lI 1 fzr Y IVe6tate License#: <br /> City: P, ccr �5 Zip: Expiration Date: 3 ��0— <br /> —;73X �a ).Cow <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. ❑Manual Disassembly Heavy Equipment ❑Other <br /> Permits) 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. Jrl I <br /> Form Last Updated: July 2015 # <br /> 150794 <br />