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O City of Orono FO USE ONLY��nn �/� <br /> P.O.Box 66 Date Received/Fe /, Permit#1,16 70/54 c� <br /> �� 2750 Kelley Parkway <br /> IL_ Crystal Bay,MN 55323 Amount: $ , V SAC Credit: <br /> (952)249 4600 <br /> � `- Homeowner(s)Signed: 0Yes <br /> Resolutions if anSigned. Yes q <br /> tiG ZoningDisclosure Signed: 0 Yes 0 None Required <br /> �xEs H O� gn ❑None Required <br /> .5CVGW ( usi L 7--csi o 3 <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> RECEIVED <br /> Job Site/ Owner information: all <br /> Type: Z Residential ❑ Commercial CITY OF ORONO <br /> Site Address: (2-g( i,( l Y(ATI TSL <br /> Owner: Tom/` r"J{{i-C, -T" Mailing Address: 1 l ' tar TPLL <br /> City: (7rt, N 0 Zip: 55313 <br /> Phone: (9(2 —p-1 ( ` 56G 5 Email: [C04,—Q vA •COW <br /> Contractor/Applicant Information: <br /> . t 1 l V �U"� `� ^k. <br /> pp . Iii\.,1\4),t,\\ �� �� Contact Person: \1� �Contractor/A � <br /> Address: 37lD L _ State License#: i S <br /> City: , �rn,Jv1-‘, Zip: Expiration Date: -3 <br /> Phone: \ -2-,5)3-6r0 Email: —A-- d\i\ 411/4 <br /> ___11\ .(-6,N\ <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 DisassemblyMeavy Equipment CIOther <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 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. <br /> Form Last Updated: July 2015 N II' <br /> 150784 �Q Q <br /> d— <br />