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' ( � • 4 <br /> CITY OF ORONO +- APPLICATION FOR DEMOLITION PERMIT <br /> P.O. Box 66 (1335 So Brown Rd) <br /> Crystal Bay, MN 55323 <br /> � SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> *�:*���***t�*****�***�:**�*�**�*�*�#******�*******t**�****�******�**:****� <br /> General Instructions <br /> l. You may be required to obtain other permits, i.e. burning, well <br /> abandonmment, etc. <br /> 2. Work must not begin unless the permit card is available on the job <br /> site. <br /> 3. A 24 hour notice is required for all inspections. Call 473-7357. <br /> �**t***:**::******�r�**::**t*�****t:#**�*************�*#**�****:***:�*�***** <br /> JOB SITS ADDRESS: �G � t;�►�, ���" �D, <br /> Occupancy Type: Residential Commercia <br /> OWNER'S NAME: /,.�/e��,�5 J Phone: Ssf�S�O <br /> Mailing Address: Z7 5 City: G <br /> CONTRACTOR'S NAME: �_C. �Q�I/57��� B u s. N o. : �j�-�''10 3 <br /> Mai ling Address: �7� /�j �" City: G <br /> **:******�*:***::******�**#**t�*****:***:*:*�****#�**��***�:*t�********:*:� <br /> Demolition if planned by means of: manual disassembly X heavy equipment <br /> burning (by fire department) <br /> Permits Issued: <br /> # Burning Fire Department <br /> # Well Abandonment <br /> In return for issuance of said Demolition Permit, the undersigned owner <br /> hereby agrees as follows: <br /> l. The structure(s) shall be kept enclosed and/or secured until such time <br /> as demolition is complete. <br /> 2. Demolition debris wiil be kept off adjoining property and/or the <br /> public rights-of-way unless specific prior approval is obtained in <br /> writing f or temgorary use thereof. <br /> 3. Foundations shall be completely removed from the ground. <br /> 4. All demolition debris shall be completely disposed of off site in <br /> accordance with alI app licable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health <br /> Department regulations. <br /> 6. Inspection required when all debris has been removed, before <br /> backfilling. <br /> 7. Within 5 working c�ays of superstructure removal , a final inspection <br /> shall be requested. The site shall be left clean and clear of all <br /> debris, with any excavation filled with earth level with the adjacent <br /> _ ground elevation (except when such excavation is to be used as part of <br /> a new building and such new building is actually under construction). <br /> � <br /> ��( ��� <br /> "I' <br />