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, , r��� <br /> . �� <br /> --- ��� <br /> /;¢p��\ City of Orono g <br /> P.O.Bos 66 FO C ONLY C <br /> �� �`;� Date Received: I Q emiit# �/v� ' � /_� <br /> f�' ,_., I� 2750 Kelley Pazkway �S� <br /> ;� ������ �� Crystal Bay,MN 55323 Amount: $ SAC Credit: �5 <br /> ,t���> ,�,.��o�° (952)249-4600 y,_ <br /> �``�°°xO�� Homeowner(sj Signed: ❑Yes ��'7�' ��� � <br /> Resolutions(iE any)Signed:Q Yes ❑None Required <br /> 'Lonin Disclos�e Si ed: ❑Yes ❑None Re uired <br /> CITY OF ORONO- DEMOLITION PERMIT signe.� �cr�w <br /> (All permits must be approved b_y the Building Official�md/or Zorung Departrnent) �Q�Cr11�y " 1�,� <br /> � �l� <br /> Job Site/Owner Informarion: �� �� <br /> Type: � Residential ❑ Commercial <br /> Site Address: 00�� ���e�P� ��, � • <br /> Owner: �h, ��uW�� Mailing Address: <br /> City: Zip: <br /> Home Phone: �,��,� ��- �1��o Alternate Phone: <br /> Contractor/Applicant Information: ,--� � r, ,,� , '� �'�^;, `� � <br /> ��i�-} � ��;����� ° . ,��"���}3 <'_ � <br /> s \\\V �--, <br /> Contractor/App.: 1v*�, ^�\ ocJ Contact Person: ��w-- <br /> Address: ���x ����0 State License #: <br /> City: �`s''b Zip: SS��q Expiration Date: <br /> Phone: 1b3-�c1a-21��\\�� Alternate Phone: ��3-`�55 - o�3 <br /> �--- --- <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 a11 inspections. Ca11 (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: �ewer Disconnection ❑ Well Abandonment # <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees to: <br /> l. 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$2,000 escrow and an escrow agreement signed by the property owner. <br /> 4. Keep all sri-ucture(s) enclosed and/or secured until such time as demolition is complete. <br />