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�O r City of Orono USE ONLY (j <br /> 1 V P.O. Box 66 Date Received: ermit# d 1 <br /> 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 ' Amount: $13p- SAC Credit: <br /> (952)249-4600 <br /> }` Homeowner(s)Signed: ❑Yes <br /> S � <br /> Resolutions(if any)Signed:❑Yes ❑None Required <br /> `g0SHD� Zoning Disclosure Signed: ❑Yes ❑None Required <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: 3�f(o S �atc�y cy� oc.d <br /> Owner: 6-S- ?KoPciz-rpt' Mailing Address: l d SOX 30 <br /> City: // �\ r� /11APcC PaT--' Zip: �`�.S-3S`� <br /> Phone: C_'1�3 1 422- 31 I '-j Email <br /> Contractor/Applicant Information: <br /> Contractor/App.: C; IJo SE7< Contact Person: IV1 A..' <br /> Address: / d X- State License#: <br /> City: /11"7'E PLATa/Zip: S-!.3 l Expiration Date: oZ0 IlP <br /> Phone: ?1,3) V 2-1 3 H T? Email: 'C) c C'-r JV-' - 6—e 5 . 4fL7— <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 <br /> issued. <br /> Demolition by means of: ❑ 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 <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. 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. <br />