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O City of Orono FOR CITY USE ONLY <br /> � � P.O.Box 66 Date Received:��� Permit# �� vz� <br /> � 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ �� SAC Credit:�� <br /> (952)249-4600 <br /> 'j � Homeowner{s)Signed: ❑Yes <br /> � <br /> F �,� Resolutions(if any)Signed:0 Yes ❑None Required <br /> ��fKFSH��� Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> CI�'���� <br /> CITY OF ORONO - DEMOLITION PERMIT . <br /> (All permits must be approved by the Building O�ciai and/or Zoning Department) � <br /> / `/' <br /> Job Site / Owner Information: �� <br /> Type: Residential ❑ Commercial <br /> Site Address: <br /> �� ����2� L�/Z� ���� • <br /> �G�.��� �-����f-�r`� s �D�� '��'�c��/G�� <br /> Owner: ailin Address: � <br /> City: �h`D�'?C1 Zip: ��.���SC� <br /> Phone:���-/C �-Q� ��/d �/� "` EmaiL• �Gf�������P���� � �"�� . <br /> �(I>�� <br /> Contractor/ Applicant Information: • <br /> �- �/�G���`����?C>' <br /> Contractor/App.: L�� ���L����� � Contact Person: / ���C�.. ����`� <br /> Address: `��r�� ����� ����� � State License #: �� �! �j 1�� <br /> City: ���/v7`7� �7� Zip: �-`��� Expiration Date: � '�"� ���� <br /> Phone: ��� ��� ��'.�� Email:���C(����fpGL/��Cl�'Ij(�/?�J���/��� ` <br /> � ��O�F�� <br /> SPECIAL CONDITIONS � 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 yD�i�s�nnection ❑Well Abandonment#__� <br /> I "I Fi <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 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. ����� <br /> Form Last Updated: July 2015 <br /> 150784 <br />