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�� <br /> , `-___.r. City of Orono F� . . ,ovL1 r �''') �.� C� �� <br /> � � <br /> ; �+-O�O�� P.O.Box 66 Date Received. __����nnit t ,_��i__'" <br /> � 2750 Kelley Parkway 1 <br /> l� ; Crystal Bay,MN 55323 Amoimt�. � � � �' SAC Gedit: <br /> � �� i (952)249-4600 c��_�� ��—� � �� <br /> ,�\? �� F�lneowner(s�Signed: ❑Yes <br /> �F'�� � � Resolutions(if a�y)Signed:Q Yes ❑None Required � <br /> `.,`�l��ti f���q.�� Zonin*Disclosure Siened: ❑Yes ❑None Rec uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official andlor Zoning Department) <br /> Job Site/Owner Information: <br /> Type: �Residential ❑ Commercial <br /> Site Address: ��•S � G qSCL� C ���I�' <br /> Owner: � ��C/'l ����s�n MailingAddress: Zy'� � w�V(,tw►1'1(�3 �lNe. <br /> City: W aU�� ��Ja � Zip: <br /> Phone: Email: ��k��Sa/1�Cuf�Sd/IC41/o��'f� Ce�/77 <br /> Contractor 1 Applicant lnformation: <br /> Contractor/App.:���C�n�l�rs(� '�XGx'✓�t'�,ContactPerson: b�� <br /> Address: �36r� �• � �� State License#: <br /> City: Ca�a �� �NZip: �f?2� Expiration Date: <br /> Phone: �/Z.- Z. 1 rJ - 7 ��6 Email:dd/�t�' �ic6t�•t�t4�l/I���`X",r��7 <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: ❑ Manuai 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: Ju/y 2015 <br /> 150784 <br />