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� <br /> , <br /> �O� City of Orono FOR CITY USE ONLY � 7,,, <br /> P.O.Box 66 Date Received: � ��- ��' Permit# 0�//l�p— '�110 <br /> � 2750 Kelley Parkway / � <br /> Crystal Bay,MN 55323 ' qmount: $ �J cJ SAC Credit: <br /> (952)249-460a �`..-.__..._ <br /> ,�s, ,` Homeowncr(s)Signed: ❑Yes <br /> E' ��,� p� Resolutions(if any)Signed:❑Yes ❑None Required <br /> �'�KFS HQ� P' 7.,onin Disclosurc Signed: ❑Yes ❑None Re uired <br /> '-- ��1� ._ <br /> v �1 <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by tfie Building Official and/or Zoning Department) <br /> Job Site l Own�r informatian: �T� <br /> Type: �] Residential ❑ Commercial <br /> Site Address. `, x -�_��_ ' � <br /> � t� <br /> Owner: ` +% t� ��._� Mailing Address: � y _i ; <br /> City: ��,..a,. �i ��� � � � � Zip: <br /> Phone: �5��' Z�S" �"�� Email: �USU'•n . ���0(�� lrt�t(�. C0� <br /> Contractor/Appticant information: <br /> Contractor/App.: � ' ; ' ` Contact Person: � � � <br /> Address � r �;��� � �i State License#: � <br /> City: � `�, + (` � ; '';� Zip: 1 r •', = Expiration Date: <br /> Phone: ti � � Email: � <br /> ( SPECtAL CONDiTtONS � 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 haur 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 /> Demolition by means of: ❑ Manual Disassembly �Weavy Equipment ❑ Other <br /> Permit(s} Issued: ❑ Sewer Disconnection ❑ Well Abandonment# <br /> , � , E <br /> , , , � �. <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. Submit 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 capy of permit approval from the Minnehaha Creek Watershed District {MCWDj. 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 />