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City of Orono r R c Y USE ONLY <br /> r V P.O.Box 66 Date Received$/�� Permit# <br /> 2750 Kelley Parkway At' <br /> Crystal Bay,MN 55323 w'V <br /> Amount: $ SAC Credit: <br /> (952)249-4600 <br /> Homeowner(s)Signed: ❑Yes <br /> ti y)Signed:❑Yes <br /> e Si <br /> n (� Resolutions El None Required <br /> gkFs t.tp��' V- r� ZoningDisclosure <br /> any) <br /> Si ned: [I Yes El None Required <br /> l �3CM <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: 3 J.. UJo►`��rW h �.d. rd v,-o <br /> Owner: Car tr- Qk Mailing Address: ��s C3�,X r� V-4- <br /> City: Zip: s * S10 <br /> Phone: Email: G0,rTf- , O 1 r T* GZJqft%ck,t:( .c4NvN <br /> Contractor/Applicant Information: <br /> Contractor/App.:AQrvkov%, �� tie Contact Person: CA-)) k <br /> Address: PD&>Y. 3djz� State License#: 19C s31gb <br /> City: M_�e.&V%Zip: �^ Expiration Date: 3- <br /> Phone: -163-L1-1q-'S LJ Email: w'Al( C Q cj ('0.Or <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 WHeavy 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 />