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F <br /> Q� CIt�/Of OfOf10 FOR CI'i'Y USR ONLY C!.�-'� <br /> i/Q.. � P.O.Box 86 I Date Kaccived: ��)'S Pamit t�o��� � <br /> � 2750 Kel{ey Parkway [� �y� <br /> Crystal Bay,MN 55323 Amoun� S OV�w SAC Credit:_____ <br /> (952)249-4600 <br /> � 1 HomcowocKs)Sigocd: ❑Yes <br /> 5'� �� Rc+olutions(f any)Signcd:�Y�v Q None Rcquued <br /> ���ES{I O'7`�' Lonin�Disclosun tii med: Y�� `lone Ita uirc� <br /> `.s�A 1I��/ 'N ��,� �.7 <br /> CITY OF ORONO- DEMOLITION PERMIT <br /> (All pertnits must be approved by Me Building Official andlor Zo�ing Department) <br /> Job Site/Owner Information: <br /> Type: [� Residential ❑ Commercial <br /> t- �� � <br /> Site Address: ��jL_�„�1'����� :f'�Y�`.Yl%�-Q <br /> Owner. ,.��.�y �"T��.r �:tF1�Y r'Y1�✓� Mailing Address: �1`�S � ��r5 /�D�Lo� <br /> City: I �LG�f f'1�, Zip: '����,�D <br /> Phone: �fr� —`-��.�"'��i �G' Emaii: J i ��v/,'Z�{h�. E,-��'.��%� iJ:�� :!.� r'�; <br /> � Contractor/Applicant Information: <br /> ContractorlApp.: , �� �t� !� ��.r'tT"�Yj Contact Person: � ''C �7�t/✓t t�. <br /> ���'" � .7 ) <br /> Address: f ����f f�ltnn•:'.���t� ��I•r�� StateLicense#: � L-�p �i��'� <br /> Ciry: ��2.(�'�h Y� Zip: �`�� Expiration Date: � �1 1�_ <br /> Phone: 4�'1�"'�� � ��-/�c�.-^ Email:J���t,�. � ;�t�,���t'�'}3��✓S. Lat'1--� <br /> SPECIAL CONDITIONS� HOLD HARMLESS AGREEMENT <br /> General lnstructions: <br /> 1. You may be required to obtain other permits, i.e.:weA 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. Cali(952) 249-4600. <br /> 4. Sewer must be discontinued at the City service by qualified contractor before demo permit is <br /> 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 undsrsigned owner hereby agrees to: <br /> 1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which <br /> structures are to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Srte Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District(MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(sj from the MCWD or <br /> documentation stating permit(s)are not required. <br />