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;��� City of Orono y FOR i��rti �se c�h[.y�
<br /> P.O.Box 66 I3ew R�c����i _�fG�-S i'��nnst tt 2fj��lfc
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<br /> `./ 2750 Kelicy Parkway � �
<br /> Ctystai Bay.MN 55323 Amuunt 5--�� �At'C rc.1�� .j�t� --
<br /> � � (952j 249-4600 ; �,
<br /> � , � N�-�mc�,µnez� �Si��r:j ❑`t'es
<br /> � Rex�hitu�as f si's�rM��1 S�paxd ❑'1'�, ❑ti��ne Reyz�.re#
<br /> �'��;�j� ��' �,t��� � � txenm Ih�.t,iwe5a ti"es ticnu;tte�wred
<br /> `-7�' ��`-��li��" C ��
<br /> CITY OF ORON� - DEMOLITION PERMtT =r��--,' j �� ,� :�
<br /> (AN permits mus2 be 8pproveQ tsy?he Budrfing;Jfftaat andro�Zun«r�rpartr�rnt'= -'
<br /> �.._____.._�_— �1�.0� b �'�J`�mi�
<br /> (, Job Site / Owner Information: �
<br /> Type: (� Residential ❑ Commerciai
<br /> Site Address t-;c:.� c� ���._��r�,�. �����}� C �- �`�= '` ' �-��1��%`l
<br /> � _ '�,�- _
<br /> Owner: i ,�. -� ��;4 7 r -, }�-?� Maifing Address: � �C��fc:� �:''��,; :�{'�.��
<br /> City: t_��r� E r�_e� � ?rp: �,��:;;-t t
<br /> Phane:,��`�;� :� ,1 :��:, t - '(r� �G- EmaiL +._T(c,.�:�:��:�_�s��.,�:_ r'r�v,-.
<br /> _._.__ � .
<br /> Coniractor 1 Applicant InformatEon:
<br /> ___-,---_ _ _ _
<br /> Contra�tor/App : :� .��:,,,,_ i, C�,����r��-. 4�c,�«f S Contact Person: ;;�f � ._-. t,��'-��
<br /> Address: [���`�x r'�..�.�����.K� �:,,z� State Lioense#_ �x 4"�°�'�`;`t
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<br /> City: �,����-�.�,�„ Zip. ��'. �� I Expiration Date- :3��?i ��r;�
<br /> '� -.
<br /> Phone: [`t��,� :�,,�t'. �;c;�1 ? Email: h�-, ,.-�. ,���:=.�t��4`t . .�e,,��,,-�����, �c�,
<br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
<br /> Generaf Instructions:
<br /> 1. You may be required to obtain other permits, i.e.: well abandanment, sewer, etc.
<br /> 2. Work must not begin un{ess the permit card is available an the job site.
<br /> 3. A 24-48 haur notice is required for al! inspedions. Cali (952) 249-4600.
<br /> 4. Sewer must be discantinued at the City service by qualified cantrador before demo permit is �"'�
<br /> issued. w\O�,d ���
<br /> \" D(
<br /> Demolition by means of� (�Manua! Disassembiy � Heavy Equipment �Other �sr I;•. �'� <. -
<br /> �ermit(s) Issued: ❑ Sewer Discannection ❑ We�l Abandonment# �� °�
<br /> �.5, f��
<br /> !n return for issuance of said Demolition Permit, the undersigned owner hereby a ees to:
<br /> 1 Submri a survey, aerial photo or sketch showing alf structures on the property. Note which
<br /> siructures are to be demofished.
<br /> 2. Submit a survey, aerial photo or sketch shawing proposed erosion control measures in
<br /> accordance with Chapter 79, Construction �rte Runotf Confral.
<br /> 3. Submit a copy of permit appravaf from the Minnehaha Creek Wafershed District {MCWD). The
<br /> City will not issue a demolilian perm�t without a capy of the permit(s} from the MCWD ar
<br /> documentation stating permit(s} are not required.
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