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0�/03/2006 15:15 FAX 65122238�1 Semple Excavating INC ��� �001 <br /> ' � - � �n ��I��I w,�-h C h �.��� � � <br /> � �, � <br /> �. _��- , <br /> .� <br /> , �/� � � �� <br /> CITY ON� ORONO APPLICATYON FOR AEMOL�T�O �ERMIT <br /> P.O. I3ox 66 (2750 K�lley Parkway) <br /> Crystal Bay, MN 55323 <br /> SPECIAL CON�ITTONS& HOLD �A,�t�VILESS AGREEMENT <br /> General�nstructions <br /> 1. You may be requa�ed to obtain other permits, i.e. well abandonment, etc. <br /> 2. Worlc must not begin unless the permit card is available on the job site. <br /> 3_ A 24 hour notice is required for all inspections. Call (952) 249-4600, <br /> JOB S1TE ADDRESS; 1225 Dickensai Streec <br /> Occupancy Type: ✓ Residential Commercial <br /> O'WNER'S NAME; Matt Hoffman Phone:���z)e�7-cz�3 <br /> Mailing Address: 15472 Filunore Street C�ty: Elk River,MN 55330 <br /> CONTRACTOR'S NA�• Stmple�xcavacing&Tnicking inc $US.NO.: (G51)772-1449 <br /> Mailingnddress: ylRidderCircle Cjt�: St,Paul,MN SSIU7 <br /> Demolition if plann�d by means of: manual disassembly <br /> ✓ heavy eyuipment <br /> Permits Issued: <br /> # Well Aba.ndonment <br /> In recurn for issuar�ce of said Dem,olition Permit,the undersigned owner hereby agrees as foLlows: <br /> l. The structure(s) shall b� kepC enclose:d ax�d/or secured until such time as demolition is <br /> complete. <br /> 2, Dcmoli�ion debris will be kept of.f adjoini�ag prope�ty and/or the public rights-of-way unless <br /> specitic prior approval is obtained in writing for tem�orary use thereof. <br /> 3. Foundations s�a11 be completely removed from the ground. <br /> 4. nll demolition debris shall be completely disposed of uff site in accordance with all <br /> applicable PCA requirements. <br /> S. Water wells�ust be a.bancloned in accordance with State Health Department regulations. <br /> G. Sewer and watzr must be diseonnected at the services at the street by qualified contractors. <br /> 7. Inspection required when all debris has been removed, before backfilling_ <br />