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':IT F ORONO APPLICATION FOR DEMOLITION PERMIT <br /> P.O. Box 66 (2750 Kelley Parkway) <br /> Crystal Bay,MN 55323 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e. well abandonmment, etc. <br /> 2. Work must not begin unless the permit card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call(612)249-4600. <br /> JOB SITE ADDRESS: NO Wlu a d✓ 012, S-ou r1-! <br /> Occupancy Type: k Residential Commercial <br /> OWNER'SNAME: � '�'n c w�l Phone: C,1? - '3-71 3 <br /> Mailing Address: 20 z P, ti v-<-o City: 6,- <br /> CONTRACTOR'S <br /> CONTRACTOR'S NAME: 1<'£i77) `✓Rr�25�.9-SSpC�. Bus.No.: <br /> Mailing Address: Gat/G /Qj . .b,re //o City: Fbrw 1'0/Z'4�4(E <br /> Demolition if planned by means of. manual disassembly <br /> _heavy equipment <br /> Permits Issued: <br /> # Well Abandonment <br /> In return for issuance of said Demolition Permit,the undersigned owner hereby agrees as follows: <br /> 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> complete. <br /> 2. Demolition debris will be kept off adjoining property and/or the public rights-of-way unless <br /> specific prior approval is obtained in writing for temporary use thereof. <br /> 3. Foundations shall be completely removed from the ground. <br /> 4. All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health Department regulations. <br /> 6. Inspection required when all debris has been removed,before backfilling. <br />