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. , <br /> O City of Orono FOR ITY USE ONLY ' ) <br /> �- � P.O.Box 66 Date Receivecy�_�Permit# �0�5_d� D� <br /> � 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 � � Amount: $ . (.� SAC Credit: <br /> (952)249-4600 ^ ��� <br /> v <br /> �y � Homeowner(s)Signed: ❑Yes <br /> �' �,� \r Resolutions(if any)Signed:�Yes ❑None Required <br /> l9KESH��� 1 ��� Zonin Disc1osure Si ed: ❑Yes ❑NoneRe uued <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site I Owner Information: <br /> Type: [� Residential ❑ Commercial C�`��''"�l D��'' �'`�'9�� <br /> Site Address: 3 g�$ �l�t2�a-y /�'V• <br /> Owner: -Sl��wi4 3�D6�X'1"���o�. Mailing Address: <br /> City: Zip: <br /> Phone: Email: <br /> Contractor I Applicant Information: <br /> Contractor/App.: �'�E+ef �t�G 6�i,�Ei !ti-. Contact Person: �3 <br /> Address: —�C�� 'r=' sT- ��� � State License #: Q G D o 8 8� <br /> City: �Cc��i/o�- Zip: �S33I Expiration Date: � 3/ �O/� <br /> Phone: (o�z- ��10- �22�o Email: R.IP�2te.N G (��6w�a.��. C.�� <br /> SPECIAL CONDITlONS & 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 Gity 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 /> JS//-� N/.} <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: July 2015 <br /> 150784 <br />