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O City of Orono FOR CTFUSE ONLY_,,, <br /> P.O.Box 66 Date Received: !J'ii Permit#o /Y-00?24, <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> A <br /> �S. .C' Homeowner(s)Signed: 0 Yes <br /> It G `1 Resolutions(if any) Signed:0 Yes 0 None Required <br /> ''SFS H 011-• Zoning Disclosure Signed: 0 Yes 0 None Required <br /> 33C.COW oaSouakA Jf zoo-00gt <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: Ell Residential ❑ Commercial <br /> Site Address: L/(AOC (A44-7-E72.-TO?,)0.-) a <br /> Owner: "j/t° SS Mailing Address: <br /> City: Zip: <br /> Phone: Email: <br /> Contractor/Applicant Information: 71/5-710 - 0 <br /> gt.,e,Jus4A- <br /> & LContractor/App.: 'l Co . Contact Person: J c--1 -c <br /> Address: )'0 IOC) -7 5-4 k.. 4-1_,,e_ State License#: <br /> City: CvrLr✓/ G/‘ Zip: SSY a Expiration Date: <br /> Phone: (01 i L L - `) .(6)3 Email: S"4-4 6xtco e v.,,,,,,.. . ,_,:...... <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 Disassembly gjeavy 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 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 <br /> 150784 <br />