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M <br /> t r <br /> ��(� l�l� l0 I�e� 1 -�r... �,rt d��-�,k"-'i <br /> � r <br /> �;'`� ' City of Orono FO CI71'USE ONLY <br /> �� �����'�,, PA.Box 66 Bate Received: � ��Permiz# ?�r r-��l �3 <br /> 2750 Keiley Parkway �KL ,n,�q,i -�, <br /> `, Crystal Qay,Y1N 55323 Amount: $_ SAC.Gcd'.r._�f' .: �:�..- <br /> i � ' (952}249-4600 <br /> �\''` ti � Hoineowner(s)Signed: ❑Yes <br /> ��i�� ,�/\ � ���' Resolutions(if any)Signed:�Ycs ❑None Required <br /> , t,�r"a!}��}�� Zc,nin Disclosiue Si= ed: ❑Yes �None Re uired <br /> ,—_.� <br /> CITY OF OR�NO - DEMOLITiON PERMlT <br /> (All permits must be approved by the Building Officiai andior Zoning Departmerrt) <br /> ' Job Si#e / C}wner Information: <br /> �---- ---------- - -- <br /> Type: [� Residential [_] Commercial <br /> SiteAddress: � y�{J /1�0✓�'l1 S�1 DVL .�►rl VL. <br /> owner: Gre�9 S�CI h �'LAtC � IVlailingAddress: ZZlPS /V,Shore D� <br /> c�ty: D rono z�p: 5539� <br /> Phone: �o�Z �b 2 3 l D 5' Email: R ►'e qq , W N1 , 5 f et h h a�t� � <br /> ( Cantractor f Applic�nt lnformation: J �!� �dm <br /> � - --- - -----� <br /> Contractor/App.:c�S STtivv�t,V� �0 �h,� Contact Person: / ►'Q.G�.1 �it�LSfO rlQ.� <br /> Address: I I D3a �A.1�')D11�- �'Y2.Nr State License #: <br /> City: `'�'A,M.OVG✓ Zip: 553�j� Expiration Date: <br /> Phone: 7�3 �fL� 9d3l� Email: 1 ►�l �o� . ►'SS�-Ct�tla,v� � L'Qyv1 <br /> � <br /> -- ----- -- ------------------------------- --- --- <br /> ; SPECIAL CONDITIONS � HOL� HARMLESS AGREEMENT ; <br /> General Instructions: <br /> �. Yau e��ay be �e�uired to obtain cther pE�mits, i.e.: w�il abanuo���ent, sewer, �tc. <br /> 2. Work must nc�t begin unless the perrnit card +s available on the jab site. <br /> 3. �24-48 hour natice is required for all inspectians. Calf (952}249-460a. <br /> 4. Sewer must be discontinued at the City service by Gualified contractor before demo permit is issued. <br /> Demolition by means of: ❑ Manual Disassembly �( Heavy Equipment ❑ Other <br /> �"s s���-�— <br /> Permit(s) Issued: �Sewer Discor�nection ❑ Wel!Abandonment# Kee.�n� W f.�� <br /> �- c�C� -�`v--�;<<j 8�- <br /> In return for issuance af saiti Demolition Permit, the undersigned awner hereby agrees to: <br /> 1. Submit a survey; aerial photo or sketch showing all structures on the property. Note which structures are <br /> ta be demoiished. <br /> 2. Submit a survey, aerial photo or ske;tch shov✓ing proposed erosion control measures in accordance with <br /> Chapter 79, Construction Site Runoff Cantrol. <br /> 3. 5ubmit a copy af perrrait approval from the Nlinnehaha Creek Watershed Qistrict (MCWD). The City will <br /> not issue a demolition permit witho t a capy c,f the permit(s) from the MCWD or documentation stating <br /> perrnit(s)are not required. ��.,��}_�G�,.�"� ��.� � �.:�� �1 �2���ct w��� ������V��'� ��� _�� <br /> Form Last Updated: July 2015 A�� ' -1 i <br /> 1507R4 � �.S(./'r �W (�l� I�! � SQ�IA-� I K ��) a W�� <br /> / <br />