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OAj City of Orono TY USE ONLYc247// �.j 25 <br /> W <br /> P.O.Box 66 Date Received: �� �`O Permit# (j11/�(O' / <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> Homeowner(s)Signed: ❑Yes <br /> Resolutions(if any)Signed:❑Yes ❑None Required <br /> HpZoning Disclosure Signed: 0 Yes 0 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: 62 j (2-0 1,3 w Z_-t-ek 8( ✓til (4use) <br /> Owner: CJ`ed ,1 EE<ckco r\ Mailing Address: 2c/3 &ho/,'n4 El <br /> City: /o1// 5 /^e-t k Zip: 5 3 S--- - <br /> phone: 612- l l 0 �3 / / Email: CV1 c kSc 11 6rc.r 6 Ve-ivG. CQen <br /> Contractor/App.: C�Ce.44'1 e ca S fl Leo .i . Contact Person: <br /> Address: State License #: <br /> City: Zip: Expiration Date: <br /> Phone: Email: <br /> SPECIAL CONDITIONS,&NOLD'HARIVILESS 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 XHeavy Equipment ❑ Other <br /> Permit(s) Issued: ❑ Sewer Disconnection El 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. N Ilk — etuk— <br /> Form Last Updated: July 2015 <br /> 150784 <br />