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� ' � ' <br /> Q/�� City of Orono FOR Ci1'Y USE OyLY <br /> P.O.Box 66 �,r'('( � ., <br /> . j/� "Y� 2750 Kelley Parkway Date Received: %]I�I,.,'� Pemut# --- _--- ._,' C���J C, �. <br /> r' �T � <br /> Crysf21 Bay,MN 55323 qmourn: ���6D SAC Creitit�-��� �� <br /> { � �ss2�2as-asoo �� ,.�,�,,�� �� <br /> �t i� ,` � [lome�a�ns)Signed: ❑Yes l' / ,� <br /> \'O� G�� /�� Resolulions�if any)Signed:❑Ycs ❑Nonc Rcyuired <br /> ��FS H U�` rl' `Loning Disclowm S�ed:_Q Ves IYone ltequired_ <br /> ��.�� <br /> CiTY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zaiing Departrrient) <br /> J�b Site!�wn�r Information: <br /> Type: � Residential ❑ Commercial <br /> Site Address: �ob ' �1 � �n�Fa �� `� � �i. <br /> � � 1�� 1�l � <br /> Owner: ��k:.� ����''►�� �'t8'rb Mailing Address: �c� ��',n�� Q,, ` � P ti <br /> City: ��t�n n Zip: �53�(0 <br /> Phone:._Ul � ��(� ,��0) v Email: Y''1ic�tie � . ���J�.�d�5 �Q Jrn�, �. c,o,..,. <br /> Contractor 1 Applicant Informatian: <br /> ContractoNApp.: �,�".�.��'�+�F- �',�v�(�5 Contact Person: _M �����h�� <br /> Address: «ti Li�%� ��'� State L+cense#: <br /> City: �� Zip: �S��c Expiration Date: <br /> Phone: �3��l� �-�S i Email: `�'i� � h��,���n,-�ci�,.� , l':��-., <br /> SPECIAL CONDlT1C?NS 8�HOLD HARMLESS AGREEMENT -�-----� <br /> General Instructions: <br /> 1. You may be required to obtain other permits, i.e.:weU abandonment,sewer,etc. <br /> 2. Woric must not begin unless the permit card is available on the job site. <br /> 3. A 24-48 hour notice is required fflr afl inspections. Cal!(952)249�60d. <br /> 4. Sewer must be discontinued at the City service by qualifled contractor before demo permi#is issued. <br /> ( sassembly 0 Heavy Equipment ❑Other <br /> Demolition by means of: Manual Di ;�_� ����� �v� <br /> Permit s)Issued: �Sewer Qisco��0 Well Abandonment# <br /> , ��` C7�?_���-7- �, _ .__ _ _ . <br /> �1�_�-�_ <br /> In return for issu�"ance of said Demolition Permit,the undersigned owner hereby agrees to: <br /> 1. Submit a survey, aeriai photo or sketch showing aN structures on the property. Note which structures are <br /> to be demolished. <br /> 2_ Submit a survey, aeria! phot�or sketch showing proposed erosion control measures in accordance with <br /> Chapter 79, Construction Site f�unoff Contral. <br /> 3. Submit a copy af permit approval from the Minnehaha Creek Watershed District (MCWD). The City wili <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 /> �orm Zast Updated: Jufy 2015 <br /> IS0789 <br />