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O City of Orono ox TTY USE ONLY <br /> �- � P.O. Box 66 Date Received:�� Permit# d�3—� � �� <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $ ��� p SAC Credit: <br /> (952)249-4600 <br /> >. <br /> Homeowner(s)Signed: ❑Yes <br /> y�' �,� Resolutions(if any)Signed:❑Yes ❑None Required <br /> `qKFSH��� Zonin Disclosure Signed: ❑Yes ❑None Re uired <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: � Residential ❑ Commercial <br /> Site Address: � '� �� ��� �fi� ��� "�'� <br /> ,- _ <br /> Owner: ���� '��S��S Mailing Address: � h U ��Z�� �-� �- �� <br /> c�ty: �T � t����� zip: :; �, ����3 <br /> Phone: �! ���� ���� Zo r1�� Email: J.:���Sc� ,ti �-z��c�-�-� �� �,-„�,��.�� , ���M, <br /> Contractor/Applicant Information: <br /> Contractor/App.: rl 1 ��'� ���°�`�=� ��' Contact Person: ,�'���� ������� <br /> J <br /> Address: ��`��� �� � �� ��' State License#: �L- ���L�`�� �°�% <br /> -� c l J <br /> City: �'� � Zip: �' � ?� � Expiration Date: � � � '"I <br /> Phone: <br /> �E 7 ��� l �1 C �t�( Email: �M���� �„�.;�:t�l � ������,, � c�� ✓�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 ❑ 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 <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 />