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` CxTY OF QRQNp APPLICATYpN �►'QR D�2iOLITIpId i'�IT <br /> j P.O. Box 65 _ . <br /> CrystaZ Bay, MN 55323 <br /> �PECZAL C�NDITIONS & HOz�D HARA�LESS fiGREEMENT <br /> t�****t�f#�r*rt**�*�*��**�***#*****�****#*t*�+r*��****�****:+t*x��*�****�a:::: <br /> G�nerml Instxuctions � � 3 �y�[} <br /> 1.- You may be required to obtain other permi�s, i.��� burn�ng, Well, <br /> abandonmment, etc. <br /> 2 . work mus� not begin unless �he permit card is av�ilabie on the �ab <br /> site. <br /> 3. A 24 hour noti�e is required for �17. inspectinn�. Call 473-7357. <br /> �**��r��*��******,r***�,r****�******���`,����*t*t*�f*f**#���*�,r****:*�:r��s*:�** <br /> sos s�� �nn�ss: Z 0�'�h �Iv�� L>� <br /> Occupancy Types •_ ,� —Residential Commercia � <br /> i1 <br /> OWIIER'S NAMR: -L� �' �G l� /(.j:� Phone: � 7 Z � �� <br /> Mai�.a.ng Address: (� �,�(���{ � _ C ty: {� <br /> �5<a� <br /> CONTRAC�dR'S NAME: ' U�-�r��c Bus. No. :.�.�-y�fZy <br /> Mailing Address: Z.�y � City:_[�pc��,�,�/��h/���� <br /> �r,�,r:�*::*�re*x��t R *��t** : *: +r�x*�t <br /> Demdlition i£ planned by m�ans ot: manual disassembly �heavy �qu�pment <br /> ^,burn�.ng (by fire department? <br /> Permi�s Issued: <br /> #� Burni»g rire Depar�ment <br /> � WeZl Abandonment <br /> zn zeturn for issuanae af �aid bemo3.ition �ermit, the unc�ersigned owner <br /> hsreby agrees as toliows: <br /> 1. The stru�ture(s? shall. be kep� enclosed and/or secured un�i1 such tim� <br /> ss demolition is complete. <br /> 2. Demol�tt�.o31 debris will be kep� off ad�oining property and/or the <br /> pub�ic zights�af--way unless speca.f�.c pri.or approval is ob�ained �n <br /> writing f or temporary use thex'eof. <br /> 3 . rounda�ions shall be completely removed from the ground. <br /> 4 . All demc�lition debris shaJ. l be compl�teZy dispased of o�£ site in <br /> accordance w�th aI 1 appZicabJ.e PGA requirements. <br /> � . Wat�r W�IIs �us� Yie abanG�031@d �73 aCCOrd�riCE Wl�h State HeaZth <br /> Department regulations. <br /> 6. Inspect�.on required when all d�bx.�s has been xemov'ed, be�are <br /> backfilling. <br /> 7. Withfn 5 working days of sug�rstruc�ure remova]. r a �ina� inspection <br /> shall be request�d. The sitie sha13. be lef� clean and clear of al. l <br /> debris, with any excava�ion �il.led with earth level witih �he adjacent <br /> ground eleva�ion (excep� when such excavatian is to be used as part af <br /> a new bu�lding and such new building is actually under cons�ruction). <br /> � �1 � <br /> �� <br />