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. ^ <br /> �`��� City of Orono � <br /> 1 FOR [TY CISE O:�I.Y <br /> ����`� P.O.Box 66 Date Received: � Permit# �U����� <br /> 0�� <br /> ���_ � 2750 Kelley Parkti�ay <br /> ��� j` *� � Crystal Bay,MN�5323 Amount: $� SAC Credit: <br /> � <br /> ' �r�..;.c� (952)249-4600 <br /> "������ Homeowner(s)Signed: ❑ Yes <br /> � Resolutions(if any)Signed:❑ Yes ❑None Required <br /> "Lonin�Disclosure SiQned: ❑Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Ofticial and/or Zonine Dcpartment) <br /> Job Site/Owner Infornlation: <br /> Type: [,� Residential ❑ Commercial <br /> Site Address: � � �'I�l �//�f��aa� �� �'�'��� � /� �5`�� y <br /> Owner: � L- �� ��f�/tJ Mailing Address: 5�! � <br /> City: 0�1'�� Zip: �� ��� <br /> 'L- - 2o `.� a l� IZ, �23 _ Gq� 2w <br /> Home Phone: ��Z� �� Alternate Phone: <br /> �'f S L ��o`� �--`7 O y��` � <br /> Contractor/Applicant lnfonnation: <br /> �- � <br /> Contractor/App.: �0 I—(�t G- �; � B�'l6� Contact Person: '� R �'I �VG {-�- <br /> Address: � � �-�' 0 ` Gov�,fL� �j State License #: �� � g`� � � �S <br /> City: � 5 Zip: ��3�� Expiration Date: <br /> Phone: ��� � �� g � °� 1 � _� Alternate Phone: � ( 'L � ��"1 — �O e `7 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions: <br /> L 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 /> 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 <br /> structures are to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> aecordance with Chapter 79, Construction Site Runoff Control. <br /> 3. Subinit a$2,000 escrow and an escrow agreement signed by the property owner. <br /> 4. Keep all structure(s) enclosed and/or secured until such time as demolition is coinplete. <br />