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O City of Orono O USE ONLY <br /> � N P.O.Box 66 Date Received��Permit# L��� O� <br /> � 2750 Kelley Parkway ,�� <br /> Crystal Bay,MN 55323 Amount: $ �/.0� SAC Credit: <br /> (952)249-4600 <br /> '� a Homeowner(s)Signed: ❑Yes <br /> � <br /> er �,� Resolutions(if any)Signed:�Yes ❑None Required <br /> lqkES H��� Zonin Disclosure Si ed: Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (Ail permks must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: <br /> Type: �Residential ❑ Commercial <br /> Site Address: � �`�� J I`(�� �t <br /> � <br /> Owner: �+(:�Lt('C� �� )��f�' ���F F� Mailing Address: <br /> City: ���� �� Zip: 5�5 �� <br /> Phone: C. i�� '����- ����-( EmaiL �i���_���'� ('������'S� ��� ' �<Gt� � <br /> � <br /> Contractor/Applicant Information; <br /> � . <br /> Contractor/App.: • V e � f ��z �'�Z�' � � ',-+'�` Contact Person: 1?�(�ri�� ' �c�'� I <br /> , / <br /> Address: d��'� � 5 �� ���1 �!�`�� State License#: �� ti <br /> f <br /> City: 1=':'�'�} ��' Zip: ����� Expiration Date: � � <br /> �n � <br /> Phone: � 1,�� :� (;.�i ' t'I`� �i � Email: ��� �� ; c�, �'�� ��l V` � �_:C�';;���,'���� I��•CU� <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 /> � <br /> Demolition by means of: ❑ Manual Disassembly [�('Heavy Equipment ❑ Other <br /> Permit(s) Issued: ❑ Sewer Disconnection ❑ Well Abandonment# <br /> �urn for issuance of said Demolition Permit, the undersigned owner hereby agrees to: <br /> �ov�Id 1 Submit a survey, aerial photo or sketch showing all structures on the property. Note which structures are <br /> 5 p�,�y � 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 ;1 OrQi <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 /> ���'s��h Corl"f'!b� P+�('M F Qn ,_j,, '�'f�`� e/- �le% l� <br /> Form tast Updated: Ju/y 2015 ��.('�Yj� � <br /> 150784 <br />