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10f21f2011 16:46 32-755-0317 FEDEX OFFICE 5�63 PAGE 03 <br /> • 5. Keep ala d�ntolition deb�is off adjoinir�B P�o��' $.t►d/or the public rights�of way un.kss specafic <br /> p�ior approva! is airtaincd in writ�ng far ter�porary a:se th�reof. <br /> 6. Completely remove foimdatio�►(s)�ront�li�g�und. <br /> 7, Completely dispose af al! deano�itxon debris oi�' site i�t accondarrce with all applic�bla .PCA <br /> requir�rnents. <br /> 8. A,bantlon wat�r wc�ls in accorda�nce with Stat�Health Department r��lat�or�s. <br /> 9. Call for atx inspectron when al.t debris h�s bcer�removed, befare backfillir�g. <br /> 10. Within S wadcing days oiFsupecstn,cture remov�l, a��al inspection sl�ll be r�quested. TF,e sit� <br /> shall be !eft clea� art�d cleat' o£��i debris, with any ��cavation ��kd with earth level with t�►e <br /> adjacent ground elev$tivn (exc�pt v�vhen such exca�atio� is ta b� used as part of a new bu.ilding <br /> and such itew buildittg is a�ctually under construction), <br /> 1 I.Abandon s�ptic systems peir Minrresota Rules Ch�ptcr 708Q. A►11 sepLic t$nks mt�st be pur�lped, <br /> crushed and �1led with native sails, An inspection is req�fred afte�r �he tar��s � �� �d <br /> before the tanks are a.rushed anrd filled. <br /> 12.The undersigned owner shall and her�by does irrdemnify and hold�aarmless the Ciry of Omna, its <br /> aSent�s, emiployees and �igns fro� and against a11 cla.i�ns, dama$es, losscs or ex�r�ses, <br /> inciudir6g attorn�y �ecs, against the City, its ggerrts, employees and assigns arisix�g out of ar <br /> resulting from the dear�rolition described hereirt as perforr�ed by th� p�operty o�wr��r, his <br /> employ�s,agents,subcornractors or essigns. <br /> PERM�T'TYPE AND.k'EE CALCULAT�ON <br /> ❑ $75.(f0—Principal Structure � <br /> �$SO.U4—Accessory Structure x�(how m�nY) � �.�- <br /> 1• Su6total of al�ve permit rcquestcd $ �fl� <br /> 2. State Surcharge <br /> 5.00 <br /> 3. �'OTA�L�EI2MIT FEL� {�dd l�ries 1-,2 a�ove) $ � � �� <br /> The undersi�aea�herby applies to the City of Omno for issuance af a I�ernoiiticm Permi�a�s to do all <br /> the wor�c in a strict accoraar�ce with th� ord�n�nces of tlte City amc� the regulatia�rs of the Stat� of <br /> M�nncsota,and certifies that a�l statements made on rhFs applicatio�arc compfete,true and correct. <br /> �.. <br /> App#icant's Sig��tnre: 0"l /_ /� <br /> Date: � <br /> � O+weer's Si��ature: ' � <br /> Dabe: I� r ^ �1 <br /> A�p�oved By; <br /> (Ruiiding Officiaf} <br /> Date: <br /> * Zaning Di�cloguire Reqtre�d? [� Y;�S ❑ NO <br /> *'i'tais must be flled out by 7oning p�pa�nt-For eitbeir answer,a Zon9ng Offoial m�st sign aIJ applications. <br /> *A►P�roved By: <br /> (�ing Official) D�: <br />