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� City of Orono ci �usE otvLY <br /> � � P.O. Box 66 Date Received:� o'Z/ Permit#� lQ� <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> � � Homeowner(s)Signed: ❑Yes <br /> � <br /> � �,� Resolutions(if any)Signed:0 Yes ❑None Required <br /> tqxFSH��� Zoning Disclosure Signed: ❑Yes ❑None Required <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: <br /> Type: �esidential ❑ Commercial <br /> Site Address: 3 �-- �y �— <br /> Owner: ��l� ���S Mailing A dress: <br /> City: Zip: <br /> Phone: �(� � � �4�- �.� 3 Z Email: <br /> Contractor/Applicant Information: <br /> Contractor/A �JC.G'1-Z/ �-t� Contact Person: �� 1�� <br /> Pp.: <br /> Address: l�`��S ���`�y n i� State �icense #: �1�v S��� 3 <br /> City: > Zip: �Z L� Expiration Date: � (�- �–/�� <br /> Phone: �l 3` �� 317 3 Email: �7��t � �� �>�N",� �-c��, <br /> � <br /> � l�-., <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 <br /> issued. <br /> Demolition by means of: ❑ Manual Disassembly��eavy Equipment ❑ Other <br /> Permit(s) Issued:�ewer Disconnection ❑ Well Abandonment# <br /> L- <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 <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 Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the MCWD or <br /> documentation stating permit(s) are not required. <br />