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.� .� � �� � �°�- <br /> ��� � � � � � <br /> �� , ,� �� <br /> r� �� <br /> �' City of Orono v (� � �O CITY USE ONLY ^, <br /> j �ON P.O.Box 66 (1/" � � Date Received:.�— ") Permit# (A �� <br /> 0 2750 Kelley Parkway �" / � � <br /> Crystal Bay,MN 55323 V' Amount: $�� SAC Credit: <br /> � I (952)249-4600 /1� <br /> �� � > � 1 /' Homeowner(s)Signed: ❑Yes <br /> �� ,�^ �� �� ResoluUons(if any)Signed:�Yes ❑None Required <br /> �` 'r-n � �. Zonin Disclosure Si ed: Yes None R uired <br /> 'FCSHO� <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Departrnent) <br /> Job Site/ Owner Information: <br /> Type: esidential ❑ Commercial <br /> Site Address: � ��C U��C����� ! ���� ��� <br /> Owner: �„�, (�� �TQ����� Mailing Address: �J��� '��'�L���t'�"� P'� �"� <br /> c��: �/�t�y?,�1�� z�P: C���1 <br /> Phone: Email: <br /> Contractor/Applicant Information: <br /> Contractor/App.: <br /> d �� Contact Person: U�a"� ��)`�� <br /> ;r , /',� � <br /> Address I I''�J� W (� � State License#: <br /> y,` �� � <br /> City: p� �`�J Zip: �� �, Expiration Date: <br /> �L�, <br /> Phone: "ISd"I��.'������� Email:�U)�I���1 ���'1.5 � rrlSn��y� <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 issued. <br /> Demotition by means of: ❑ Manual Disassembly ,�Heavy Equipment ❑Other <br /> Permit(s)Issued:�Sewer Disconnec6on ❑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 structures are <br /> to be demolished. <br /> 2. 5ubmit a survey, aerial photo or sketch showing proposed erosion control measures in accordance with <br /> Chapter 79, Construction Site Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will <br /> not issue a demolition permit without a copy of the permit(s) from the MCWD or documentation stating <br /> permit{s)are not required. <br /> Form Last Updated: July 2015 <br /> icn�vn <br />