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1 <br /> O City of Orono R TI'Y USE ONLY /� <br /> P.O.Box 66 Date Received: � Permit# v?D� 'D�/� <br /> � � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> �, � Homeowner(s)Signed: ❑Yes <br /> E' �, Resolutions(if any)Signed:�Yes ❑None Required <br /> l�KESH��� Zonin Disclosure Si ed: ❑Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site ! Owner Infarmation: <br /> Type: �Residential ❑ Commercial <br /> Site Address: /��" �! t�� � �° i�! S�'S�r/�� �/�� ��..�. N �(v.v� •L.�-•�� <br /> Owner: ��L�� �13i'n11._� Mailing Address: ��b=y �rcJio, �<y�,�! �'���,v <br /> City: �r��C� Zip: =�J`��S`� <br /> Phone: fi i,� - ���'�� -//3� Email: <br /> Contractt�r/Applicant Informatiom ' <br /> r �� : �,, _1 <br /> Contractor/App.:s�� '1 C�'�.�I���'tdntact Person: �9�n r�.l� <br /> J <br /> Address: O��a�� C.OG�7-N �� 9� State License #: <br /> City: �� 0/Y Zip: ��� Expiration Date: <br /> Phone: (p/����� ��C�9 Email: <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 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 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 witl <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 />