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� - <br /> � � � <br /> ���� City of Orono FOR CITY USE ONLY <br /> O O P.O-Box 66 Date Received: l-/l-I� Permit# /3 -DD � <br /> C� �;,.,.,__ 2750 Kelley Parkway ��'� <br /> ���'� = � Crystal Bay,MN 55323 Amou�t $ SAC Crcdit: <br /> � °i���r��ti o - (952)249-4600 <br /> z��8�„ <br /> �_� Homeowner(s)Signed: �Yes <br /> Resolutions(if any)Signcd:❑Yes ❑Nonc Rcquircd <br /> Zoning Disclosure Signed: ❑Yes �None Required <br /> CITY OF ORONO- DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Type: � Residential ❑ Commercial <br /> Sitc Address: �I I�S(- �1nLi,1'��'Y'� -�� <br /> Owner: �c7�-{- 7'1�1,i.S��, ������ Mailing Address: ���5 ��- ��t�1 '�'r5 � �r <br /> � <br /> City: )�'lI�1VI���r.5� Zip: �3� ��} <br /> Home Phone: GJ�� � �-17.�=�%4 7.3 Alternate Phone: <br /> Contractor/Applicant Information: <br /> Contractor/App.: I�-,�,�I �c.L�fi�'i)I ��1'It�'� Contact Person: aj�(�' ���✓�(�iti�) <br /> Address: ������ r�'��'C� ����� State License#: •�''� �S�%'� <br /> b ,Ql�ti���� 3 <br /> City: �`� Zip: -%j�� Expiration Date: � '� � " Z�� <br /> Phone: q� � `f 7� `� `7�/ Alternate Phone: 1�-?-`%7 �.G_>� <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. Wark 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 /> 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 structure(s) enclosed and/or secured until such time as demolition is complete. <br />