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� <br /> �, �'CITY OF OROti'O APPLICATION FOR DEMOLITION PER�ti'IIT <br /> P.O. Box 66 (2750 Keiley Parkway) � <br /> Crystal Bay, MN 5�323 <br /> SPECL4L CO�ITIONS & HOLD HAR�II.ESS AGREE_I�NZ' <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e. burninJ, well abandonmment, etc. <br /> 2. Work must not be�in unless the permit card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call 473-7357. <br /> JOB S� �D�SS: %�� C-I�G�� '���� ������� _ <br /> Occupancy Type: �Residential Commercial ��, ,� <br /> Lii — c< f- `a>u- <br /> �Otii�'ER'S NQutiIE: l Z- G�G, �_T� ..�1�CG�,S�-s t Phone: '72G-�Z�_ <br /> Mailin�a��IAddress: ��? � d Ciry: - G L�t��3�( <br /> �w�- !��: (�,5�t; /�Lf�-���'�°v�- e_ �,F. `�l�LS� /v( t� iLL N 55 3GS <br /> CONTRACTOR'S NA�1�: �T��iY�S ����vi�� ��-c� Bus. No.: �� �'L`7-y`70� <br /> Mailing Address: l�� �7��Zr (d�°� .S� � City:,.._/Z�G:S /�'1N <br /> � <br /> Ssy/� <br /> Demolition if planned by means of: manual disassembly <br /> �_ heavy equipment <br /> burnin� (by fire department) <br /> Permits Issued: <br /> # Burning Fire Department <br /> l��--- <br /> �Vell Abandonment <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as <br /> follows: <br /> 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> comple[e. <br /> 2. Demolition debris will be kept off adjoinin� property and/or the public rights-of-way <br /> unless specific prior approval is obtained in writing for temporary use thereof. <br /> .� <br /> 3� Foundations shall be completely removed from the ground. <br /> �� <br /> 4. All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> / 5 Water wells must be abandoned in accordance with State Health Department re�ulations. <br /> � <br /> 6, I���on equired when all debris has been removed, before backfillin�. <br /> � � <br /> . C�.�j C',-�r.� �a-1/ ��7 3 � �7 �S7) <br /> -t�'�- -� c�eGre�a�-� <br /> - �� � l �--�"� • r �i a c.�c.1'a,� c.�, � . <br />