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�" City of Orono Fo_��E ONLY � <br /> ���ONO� P.O.Box 66 Date Received�� 7 / Pemut# � S-0 <br /> � � 2750 Kelley Parkway -7 <br /> ; Crystal Bay,MN 55323 Amount: $ ! •�� SAC Credir. <br /> ( � ,� (952)249-4600 �C' C�f���Ir <br /> � � =� Homeowncr(s)Signcd: ❑Yes �- '-��� ` <br /> .� : i` --3 �,� <br /> �r� �j' Resolutions(if any)Signed:0 Yes ❑None Required <br /> �qkl,F{l��t�/ Zonin Disclosure Si ned: ❑Yes ❑None Re uired $ <br /> -- L��,i ����r:_�lcc1 li ,2 ►� IZCG��.� =;1_ j}—ia'v� <br /> t�,(_�K i,,_�� �' �V�D�' <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building O�cial and/or Zoning Department) <br /> Job Site/ Owner lnformation: <br /> Type: � Residential ❑ Commercial <br /> Site Address: 3� 8 � �u.-� G� C�l r� � , � �''O ✓i O <br /> Owner: � W� + S�r'QI� S�u..Ck Mailing Address: 3�6Z l�O►^��°r✓1 �}Ve- <br /> � k ��� g � <br /> City: s�17�� n� QQ,r Zip: <br /> Phone: �sZ ' ZZ� " d SZ-3 Email: ��Lt�� SS.3 g��2 � M41 I <br /> Contractor/Applicant Information: <br /> SoncPP�✓' a.czrc$ For�i,�r � �,Q <br /> Contractor/App.: � ��c���S Contact Person: --��-� �D n���Q''�`-" <br /> Address P� �d X ��� State License#: Q � � � �a � � <br /> 1 5�3 S� Ex iration Date: 3 �3 � — � � <br /> City: � i��"Of'�(�.. Zip; p. <br /> Phone: C-� I Z! g �I 9" � I 8� Email: � �S D n c��r � � r►�Q r�I . �o m <br /> SPECIAL CONDITIONS 8� 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 /> =:l 5���� �i 5//l�� <br /> In return for issuance of said�Demolition Permit, the undersigned owner hereby agrees to: <br /> 1. Submit a survey, aeriaf 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 �✓ �v �I <br /> 150784 <br />