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� ,��, � <br /> ,,��-����, City of Orono � iT��usE oxLY <br /> ��/�\� P.O.Box 66 Date Received:'���� permit# `ZL'' «C'�'�� ��S � <br /> � 2750 Kelley Parkway <br /> � Crystal Bay,MN 55323 Amount $ SAC Credit`�, � � <br /> � � 1 (952)249-4600 � �� _� <br /> �� � , ti� Homeowner(s)Signed: ❑Yes <br /> �'f f v r Resolutions(if any)Signed:❑Yes ❑None Required � (�-�(�- <br /> .?kFSt�i��?�,� Zonin Disclosure Si ned: ❑Yes ❑None Re uired � <br /> � _.... - E�'OV� VC�-��W <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site /Owner Information: <br /> Type: �'Residential ❑ Commercial <br /> Site Address: �� � as ,�A -� <br /> Owner: ��Y� �7�� �� °��S Mailing Address: /'�.�J`�rcqtr/I r✓� �?''JiIIv�� <br /> City: f�,��, Zip: � <br /> ---T� <br /> Phone:��z"�Z —o��Z Email: /�/� ~ -CD� <br /> Cen±r?ctor/Applicant Information: ` <br /> �--, , � <br /> Contractor/App.:�►�� ' �� � �1'CLC�(,�i I��Contact Person: ' ; _ <br /> , �`✓� <br /> Address: �-f-�✓ (,1.��'��� � State License #: <br /> City: ��C��'v Zip: ��3�� Expiration Date: <br /> Phone: �L" J��J�` ��'�Z Email:�% Pi'iGP CL�nST� Q �/�"A� �-�"O� <br /> SPECIAL 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 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 /> Demolition by means of: ❑ Manual Disassembly [�Heavy Equipment ❑ Other <br /> Permit(s) Issued�Sewer Disconnection ❑ Well Abandonment# �� <br /> , � �ap �� �-� � r�us�e ��' <br /> ��� In return for issuance of said Demolition Permit, the undersi ned owner hereb a rees to: <br /> nL, �`� g Y g <br /> V �\ 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 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. / �� i ����-,���f- �_� ��M� I � <br /> ;� L <br /> Form Last Updated: July 2015 � `� '��� � ��.I I I � �-Y,L•� � E�` /y��(�,�5 <br /> 150784 C C <br /> LJ <br />