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�O� City of Orono c usE oxi.Y <br /> P.O.Box 66 Date Received � / Pernut# �= � <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 pmount: $ > >• G✓SAC Credit:� <br /> (952)249-4600 <br /> y� ,` Homeowner(s Signed: ❑Yes <br /> �,� Resolutions(i )Signed:Q Yes Q None Required <br /> l�kFSHpR�' Zo Disclo Si Yes NoneRe ' � <br /> ��5�1'O�N S�"�'_ <br /> CITY OF ORONO - DEMOLITION PER IT � <br /> (All permits must be approved by the Building O�cial andlor Zoning partment)� <br /> Job Site/4wner lnfonnation: <br /> Type: �(Residential ❑ Commencial <br /> Site Address: � I `-��l� <br /> Owner: STow�(.Ja►w.� L�-C_ Mailing Address: �5� �G LA/l�S-�- <br /> City: ��'�'�} Zip: 5-53�1 <br /> Phone: l.�f 2-���0�--- ��d Email: � <br /> Contractor/Applicant tnformaiion: <br /> Contractor/App.: s��' P�./ � Contact Person: �/ <br /> Address: 1��/� v����U �,� State �icense#: �?'lo S� 13 <br /> City: IT�i.el� Zip: l�'l�SS�"I�Expiration Date: ��.- �-�� <br /> Phone: y l���� ���� I - l I ��(_� Email: an., � a � , �� <br /> SPECiA�.CQND�IT�lS-&Mt3LD H�IRMLESS A REEII�ENT <br /> General Instructions: <br /> 1. You may be required to obtain other permits, i.e.: well abandomm �t, sewer, etc. <br /> 2. Work must not begin unless the permit card is available on the jo site. <br /> 3. A 2448 hour notice is required for all inspections. Call (952) 24 600. <br /> 4. Sewer must be discontinued at the City service by qual�ed contr ctor before demo permit is <br /> issued. <br /> Demolition by means of: ❑ Manual Disassembly �eavy Equipment ❑ Other <br /> Permit(s) Issued:,�Sewer Disconnection ❑Well Abandonment# <br /> In return for issuance of said Demolition Permit, the undersigned o ner 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 Site Runotf Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek W ershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the rmit(s) from the MCWD or <br /> documentation stating permit(s) are not required. �� � <br /> � <br />