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�O� City of Orono FOR CITY USE ONLY <br /> P.O.Box 66 Date Received:(Q•k�t S Permit# ��7 <br /> � 2750 Kelley Parkway �>C <br /> Crystal Bay,MN 55323 �V� Amount: $� SAC Credit: <br /> (952)249-4600 . �/ <br /> y ,� 1T Homeowner(s)Signed: ❑Yes <br /> `O� C.� � � Resolutions(if any)Signed:❑Yes ❑None Required <br /> �kFs f{p��' /1�I���\ Zonin Disclosure Si ed: Yes <br /> I � `�„ � ❑ ❑None R uired <br /> ul `�f�, <-7l Cti.1�{✓ /� 1 <br /> CITY OF ORONO - DEMOLITION PERMIT �1 <br /> .�%��� g'/Z�"��'9' <br /> (All permits must be approved by the Building Official and/or Zoning Department) <� �1�'"�`�� r"`^'Ci� <br /> Job Site/Owner Information: <br /> Type: �( Residential ❑ Commercial <br /> SiteAddress: a� �� �--�4'1� � � , �v�-I.�ZG�=�, IY�Y1 J�3e� I <br /> Owner: �VC'�� �QS��" �(}�r���1SeS Mailing Address: �1��i �l� Jrl�r� 1��' fV'� <br /> c�ty: m�vr�c�l z�p: 5� 3�11 <br /> Phone: �Gl �.-��.��` ��1 �( �( Email: � � 'fl� �F:1,'�' c� ��� S�-Pi��-c'r�-�r iSt=S ( Oi� <br /> Contractor/Applicant Information: <br /> Contractor/App.: Contact Person: ��►Yl �'��'Ci�' �( <br /> Address: \ ���� �� State License#: gC �; � t,�� <br /> , <br /> City: Zip: Expiration Date: � �3 i�� � <br /> Phone: Email: <br /> SPECIAL CONDITIONS 8� HOLD HARMLESS AGREEMENT <br /> General I nstructions: <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 <br /> issued. �.�,,,�a�r: c.c�:�� J�yce.�iw-� t��_ l�s�� is �� <br /> �hat c._ l s ttix� 3�.1�—v,a+.� t-� ,��_� ���st--. <br /> Demolition by means of: [�Manual Disassembly ❑ Heavy Equipment ❑ Other <br /> Permit(s) Issued: ❑ Sewer Disconnection ❑Well Abandonm�#O/L`L. <br /> by e�Cca�a--1-c�-- — �o =;�z�.�.r•�.,.4 , ;t�.�,� • • �-�.�er. f��.:� �s� :`� <br /> �' L+�:s ��. i � <br /> In return for issuance of said Demolition Perm�t, t�ie�ndersigned owner hereby agrees to: � � <br /> 1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which <br /> structures are to be demolished. �� �c,,.�.s�- p�w,...� t�Pe�•��•� �'�, J�� �.x�. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Site Runoff Control. ,��.. Gr.�.t:� $«-x`� �1•�-.���� <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the_ M,CWD or <br /> documentation stating permit(s) are not required. S6`S� G•�.�� e�-►+ti=� 1�-p��•�.n.� <br /> �4 t�.a a�-f-.t�— l.�\�� ��. <br />