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�O� City of Orono F R CITY�E ONLY �� �,� �9 <br /> P.O.Box 66 Date Received: Permit#��11LLJ"'C/ �� <br /> � 2750 Kelley Parkway �,� <br /> Crystal Bay,MN 55323 Amount: $� SAC Credit: <br /> (952)249-4600 <br /> y ,�' Homeowner(s)Sigaed: ❑Yes <br /> �� �G` Resolutions(if any)Signed:[]Yes ❑None Required <br /> '�ESH�4 Zonin Disclosure Si ed: ❑Yes ❑None Re uired <br /> _ ��r��ti� �����k.l� t 5��f��t(`-� <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> �-(�ClZ�ti' j��t U� <br /> (All permits must be approved by the Buiiding Official and/or Zoning Department) <br /> Job Site t Owner Information: <br /> Type: � Residential ❑ Commerciat <br /> Site Address 1y�Z� t�Ll►L �c-( R �U ( �C� <br /> Owner. Sj�v� ��Lr Q ��" Mailing Address: l�ld�0 baLc�K��5� R�C �� <br /> City: Q�.p 1�.9 � Zip: <br /> Phone: 952 ��D 2� S�� Email: �G��i�0��" 11.��7���t. �'Q�/ <br /> Con#ra�J�p�l�can# In#ormata�n: <br /> Contractor/App.: �� �-f w� Q ��C Contact Person: �C7� �-' Ke��� <br /> Address: ?O� $ �'��,-,�Q� ;�/ �, Q State License#: e 6 3 S�� 2 <br /> City: �c�e N PRQ i 2�t Zip: ��6 Expiration Date: �� /_ Q Gr, 2,p�,� <br /> Phone: h!� 2�-�3 � � Email:�s tr{�cl�-4 ,��i� l�/�'..a.�4 �L• �� <br /> SPECIAL CONDIT1t3N5 & HOLD HARMLESS AGRE�MfNT <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 /> ��$;\� <br /> Demolition by means of: ❑ Manual Disassembly �Heavy Equipment ❑ Other ��;��� ��i��,� <br /> Permit(s) Issued: �] Sewer Disconnection ❑ Well Abandonment# `'��£ �`v��`'���,� ��r' <br /> ��� ��� � <br /> 'T j<,���L ��(l.Y(1`� <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 Confrol. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCW .] iy��rill <br /> not issue a demolition permit without a copy of the permit(s) from the MCWD or docu���i���at�j <br /> permit(s) are not required. <br /> Form Last Updated.� Ju/y 2015 �� ����� ��� � � ?��5 <br /> iso�ga CITY OF O�ONO <br />