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N <br /> � City of Orono � FOR CITY USE ONLY <br /> P.O.Box 66 l�� Date Received:3"lv"� Permit#O�� � <br /> � � 2750 Kelley Parkway (', <br /> Crystal Bay, MN 55323 ���N'�o�A�1N`e Amount: $��_ SAC Credit: �''� �i"�- <br /> (952)249-4600 � -, <br /> r=r c-7? <br /> �, ; y� Homeowner(s)Signed: ❑Yes <br /> �' �, t-, , .�-� � Resolutions(if any)Signed:0 Yes ❑None Required <br /> lqk£SHO�� j ���' �. ,`'`��I Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> �. �.�� �, �:SGI�GW �CG�n� r �►� <br /> � � � � <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) R��EiVED <br /> Job Site / Owner Information: MAR 0 8�Q11 <br /> Type: � Residential ❑ Commercial CITY OF ORONO <br /> � <br /> Site Address: /��S ����� T"��.; k��>r <br /> , � <br /> Owner: �..��`b:�f.� 1"��'+�U-� t� Mailing Address l%c�� /'�1,���.,�t� �ir.�c� , �''�r�' <br /> � <br /> City: �vZrr�u Zip: ��3`�I <br /> Phone: �i z-- '-r��- �}�t-�I-3 Email: b�����tiv�I��?6:��'i,z.���e���r��ft��,csw� <br /> Contracior/Applicant Information: <br /> Contractor/App.: C 1��.�le-y �dc� �c: , Contact Person: J�'�'�r ��:��'`�� <br /> Address: ���'�� ��Y�� ��t- �� State License#: �� � 3� ��� <br /> City: ������t� Zip: 5�y�-F 7 Expiration Date: .3 �3''�ui'7 <br /> Phone: �� 2- ZrrL-�E t'3 Email: ���� ,-����.� �'- c�1��.�r(�u..:c�c). �.. �-� <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 afl 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 structur�s are <br /> 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 <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 /> Form Last Updated: July 2015 I� Oq � <br /> 150784 � � <br />