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�-----_ <br /> //�ON� City of Orono Fox c�Tv t;sE o�vLv <br /> P.O. Box 66 Date Received: �'�. ' Pennit#���(�� �� <br /> � 2750 Keiley Parkway <br /> � '� Crystal Bay,MN 55323 Amount: $ �SAC Credit: � <br /> (952)249-4600 <br /> y � ,� � Homeowner(s)Signed: ❑Yes UCI C'i2�� ' <br /> F' � n- Resolutions{if any)Signed: �Yes ❑None Required <br /> !�f S}�O�'�i� I Y ( "Lonim�Disclosure Si ned: ❑Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Offlcial and/or Zoning Department) <br /> Job Site ! Owner Information: <br /> Type: [�Residential ❑ Commercial <br /> Site Address: �-��/S� �-i��e (O !'C�f av-�_ �/�,�n <br /> Owner: ,4 h�e���c �� Y'�,�crs o r� Mailing Address: �-�'�/.S' L��/c Q r��,gh�L ly�� <br /> � <br /> c�ty: r��,Q z�p: SS'3�/ <br /> Phone: �s�' �a D y a-/�9 Email: _G��n ��i e .v �i w1�c�/. �Or� <br /> Contractor/Applicant information: <br /> Contractor/App.: S�r�s ���(�'�•�_� Contact Person: Rm c h �fj� <br /> Address: f D �o� �'�f� State License#: <br /> City: z� Zip: SS� 9' Expiration Date: <br /> Phone: �!a1--�6G'9,�-�� Email: S�M_S �a��S�« c� � C�r�a�l �o�� <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General I nstructions: <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 quafified contractor before demo permit is issued. <br /> Demolition by means of: �V}anual Disassembly �Heavy Equipment ❑ Other ��� l �� �� <br /> Permit(s) Issued: ❑ Sewer �c r�ection ❑ Well Abandonment#___�' � 1 � <br /> � � ! \ <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 al{ structures on the property. Note which structures 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 <br /> 150784 <br />