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Q City of Orono ITY USE ONLY <br /> � �^ P.O.Box 66 Date Received:���S Permit# �= <br /> V 2750 Kelley Parkway <br /> ' Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> '� � Homeowner(s)Signed: ❑Yes <br /> ,� <br /> yF �,� Resolutions(if any)Signed: ❑Yes ❑None Required <br /> {7'�ESNv�� Zoning Disclosure Signed: ❑Yes ❑None Required <br /> C�'`,C.UC-- �l K C�N.cXi- Ll��h"vW�Y v' <br /> CITY OF ORONO - DEMOLITION PERMIT Q ������ ���1) <br /> (All permits must be approved by the Building Official and/or Zoning D� t) <br /> Job Site / Owner Information: �,p��� <br /> .�.�,� <br /> � \ � <br /> Type: �'Residential ❑ Commercial �Q�., -� , <br /> �Q��,J�1" � <br /> Site Address: l � � � �� . �. ��♦J�" � <br /> , �N A <br /> Owner: 0 E� Mailing -� � �s� /�f� �� �D <br /> � � <br /> City: �L��}� Zip: J'����0 <br /> Phone: Z�P3 - 'rJ,'r�7-Z l ( I Email: �at-lrI � �����J�'��5.�o�., <br /> Contractor/ Applicant Information: <br /> Contractor/App.: /Ut)K-'t'o�1 ��u� Contact Person: �tf�IS �Oit-r�� <br /> Address: �-?/dl�- State License #: ��.�oJ���-� <br /> City: Zip: Expiration Date: �4� 2�� <br /> Phone: (o I Z -�v'8�o-7��0� Email: CK�-I�I�N��Z�J t�-c�+t,l�5� �-��`ti- <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 ,�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 struGtures 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 />