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�O City of Orono o c �r rs�o;v�v p <br /> �O P.O. Box 66 Date Received���Permit# �5�/� % <br /> �� 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $,�� SAC Credit: <br /> (952)249-4600 <br /> '' �` Homeowner(s)Signed: ❑Yes <br /> F �,` �� Resolutions(if any)Signed: �Yes ❑None Required <br /> !�K£S ti���� ( �� Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> "t� �xr1iW �r(j�i�tix:'i f� 1'L�'��. <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> r l�v�w �� <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: I O SO ����W U0� �� �� S �.UGI � <br /> P�r�xz�c:{ Sf�i ri�r <br /> Owner: Qt- `�p� "=��s � �Ur , Mailing Address: I g 4� V�i 11 pW l�. 1� <br /> City: (�.� I �'l GI Zip: 55 3�-o <br /> Phone: 71�3 ' ��� — �3�5 Email: Gh I G. Gh i�-h.� @ �j'n�� I � CA'rn <br /> Contractor/Applicant Information: � ��bGtX�a � <br /> Contractor/App.: S�"Y'�fiP�lf' d- {�,SSO(�1��ontact Person: Sfi����'"� S�E'�te r <br /> Address: ��3� � M}'� �l J� State License #: BL�O � ✓g O <br /> City: V�GI �G1 Zip: 55�1 1 Expiration Date: � �31 �`3�1 �v <br /> Phone: G�-�, y�-�-C1 — �'-�� Email:��'r 1'P���,�I'� (�� S�PX+Q Y��"1C�0+(Y�1�S= C�(`� <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions: <br /> 1. You may be required to nh+�' permits, i.e.: well abandonment, sewer, etc. <br /> 2. Work must n�+ "� �it card is available on the job site. <br /> 3. A 24-4� S� inspections. Call (952) 249-4600. <br /> 4. Sewer r �� `y service by qualified contractor before demo permit is <br /> issued. �� � <br /> < <br /> Demolition by me � �f11�' �ly Heavy Equipment ❑ Other <br /> . � � �� � - <br /> Permit(s) Issued: �� '�n.,'I I LJ Well Abandonment#—������5 <br /> In return for issua��ce 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 <br /> structures are to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Site Runoff Control. <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 MCWD or <br /> documentation stating permit(s) are not required. �I� _��� <br />