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O City of Orono � OR CITY USE ONLY �� <br /> �- � P.O. Box 66 �` l�� Date ReceivedL��� Permit# �G/,j-�..� �«.�,� <br /> � 2750 Kelley Parkway �� <br /> Crystal Bay, MN 55323 '� Amount: $�d�,� SAC Credit: <br /> (952)249-4600 <br /> � � Homeowner(s)Signed: �Yes <br /> yF � <br /> �, Resolutions(if any)Signed�❑I�es ❑�Ione Required <br /> l�kESH��� Zonin Disclosure Si ned: ❑Ye None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT RE�EIV�D <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: � SEP 2 4 2015 <br /> �ITY OF ORONO <br /> Type: � Residential ❑ Commercial <br /> Site Address: �3 �� �����5� <br /> Owner: �-� Zi�"z 1o�tT Mailing Address: ��SS S�1�i.�V t�� �`�• <br /> City: �X CC' �$ i�f Zip: .SS ��% <br /> Phor�e: 1_�Z - Z f O - O Q'S� Emai�: k� �Z C.1, Z.@ °rM�c.+� . CQ�'a'1 <br /> � <br /> � Contractor/Applicant Information: <br /> Contractor/App.: �Si�rhr�n;� C�D��S��'ta� Ll.Ccontact Person: ���c.I� �rP�-�'�?i <br /> Address: � �- ��C J�� State License #: �C �Z 6 c� 9� <br /> City: � ro�C L Zip: .SS� � Expiration Date: 3`3/' � � <br /> Phone: d 1 Z � 247 - �°J� Emai�: $�^^m�tb:�c,��t��qm�.i I . Co� <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT ` <br /> General I nstructions: <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 �[Heavy 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 4� � <br /> 150784 <br />