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P a BOR 60 <br /> v ; 2?WKe ey FMMwy <br /> (9249 SSJ ) aw.mc s_ snc'iy/e�dtr. <br /> BrwtmimIN ah)timedYa I*-REW&W <br /> `�4i.trOK� t Maw" vee E1.liftaimd <br /> Af <br /> CITY OF O-Wtoy -DE-xiMea-Vo HERMIT :P0a j- <br /> rRt perrnec mirk ba•gppovrtl br se x+41 amm`a 7arNpitepuaaysfF <br /> _Job Site f Owner tntonttetiort��i <br /> Type: ;,Residentiat Commerciai <br /> Site Address: �_`*G � <br /> dam' Mailing Address: � j&%t PJgD(i fj f'(J <br /> City: ���'. Zip. PRIM I I MA4j S S3S <br /> Phone:_ -rC 1 EmaW: <br /> rCorWactor Appkcartf p�pjkc, , i <br /> Contractor/App- M.I (�t Person: <br /> A�ress: '" 90ste License At. <br /> C#y: _ Zip: ✓» ExpiuMon Date: <br /> Phone: ( � Email: <br /> SPECIAL 9QNWI?Q/i8 A HOLD HARMLESS AL3 IT <br /> Genend Insbucltons: <br /> L You may be required go obrein other permits,i.e.:wet abandotYruM sewer,es:. <br /> 2. Wbrk num mat begin uriess the pem*cards awl&d*on the job sits. <br /> 3. A 24.18 bout nobce a required for at inspections. Cal(tt62)24s4lSOD. <br /> 1- Sewer mast be*Aon rotted at the City senioe by qudr*d cmwactor before demo permit is issued. <br /> Demolition by means& Mowll Disaseanf* N Meavy tcqup nwm ❑outer <br /> AermN(s)tssuerkDisconnection [I wet Abaridonamit# -m pc <br /> In mwm for Issu�f said tDemoft"Pwmlt,um undersigned owner hereby agrees to: <br /> 1. Submit a survey,aerial photo or sketch strewing sO smxwms on the property. Pate which Wusrises are <br /> to be dem ilsh". <br /> 2. Subn*a survay,send photo or sketch showing proposed erosion control ffessures in accordance with <br /> C./dPW 79,Corrsaoc*n Sde RWWffConad. <br /> I Submit a copy of perm[approve)from the Mkini m Craek Watershed District(MCWD). The Cay wii <br /> not issue a denwWw permit wkhcmA a tops of the permlt(s)hon!the MCWD or dommapaticn staff <br /> wwriks)are not mqusad. <br /> Form Low UAfted J*2W5 <br /> ?5ff7w <br />