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� b� �i( �l�`�`� <br /> �w�� � ���� <br /> City of Orono FOR CIT i�SE ONLY � <br /> �-ON P.O.Box 66 Date Received: �'���`���Permit# d�U v/ �� <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $ �b• SAC Credit��,,� <br /> (952)249-4600 1 L%z4/ <br /> � � Homeowner(s)Signed: ❑Yes <br /> � <br /> F �,� Resolutions(if any)Signed:❑Yes ❑None Required <br /> `q/�FSH��� Zoning Disclosure Signed: ❑Yes ❑None Re uired <br /> � �j����;� �'l.� ,3�,' 1 J <br /> CITY OF ORONO - DEMOUTION PERMIT Lmsq y-�- �S <br /> � i�-1S <br /> (All permits must be approved by the Building Official andbr Zoning Department) (y/lYYJ� �d <br /> �m� 3--�G-I� <br /> Job Site / Owner Information: <br /> Type: [�.Residential ❑ Commercial <br /> Site Address: % `�t � �C� L'�}'" �-' �l./ <br /> .-, �.� �r <br /> Owner: ;�_�����l 5� �/�-.�_ Mailing Address: � � � Z� �� <br /> _j_._ ��� ��� Zip: � �: � L� � <br /> City: �7 / <br /> ��„� `, Phone: � �' � � �1 I 1�G��1 � Emait: lM���L �:.i r�T�f�� ���..5 ►�UvL . � D �'!� <br /> Contractor/Applicant Information: <br /> Contractor/App.: / //�S�/��/'����5 Contact Person: ��G�� ������� <br /> Address: S�1�10 ��C������L� State License #: <br /> City: �i�l�'� L��� Zip: 7� 31Z Expiration Date: <br /> Email: '�SC�� l�+�t��it�� f�'�'��i . YI � � <br /> Phone: (��Z-y��-I-�ZUCU �//7 y <br /> -� <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT i <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 all inspections. Call (952) 249-4600. <br /> 4. Sewer must be discontinued at the City service by qualified contractor before demo permit is <br /> issued. <br /> Demolition by means of: ❑ Manual Disassembly �Heavy Equipment ❑ Other <br /> i <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 copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the MCWD or <br /> documentation stating permit(s) are not required. <br /> _ �_ ��sic� C.ay►hol -�FN- <br /> i 5 -�1����- <br />