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t , 1 <br /> CxTY QF ORQNQ APPLICATYGIN �'QR D$liOLITiQN PSRI�LIT <br /> P.O.. Box 66 <br /> -Crystal. B�y, MN 55323 <br /> SPECZAL CONDITIONS & HOI�D HARMLESS AGREEMENT <br /> t��***:�t+r��***�*��****�*�*:****�****�#*t*��******�*:**::*,�*��t�*3*:*::�r: <br /> Gener�I Instructivns ��i� � <br /> 1- You may be required to obtain other pErmi�s� i.e. hurn�ng, well, <br /> abandonmment, etc. <br /> 2 . Work must not begin unless �he permit card is availahle on th2 ]Ob <br /> site. <br /> 3. A 24 hpur natice is required it�r a�J. insper.ti .nn�3. C.all 473-7357. <br /> re***�r�**#*�+�rr�**,rrr*****************�*�*****:*******t��**��**,r*:*�::s�sx:�*x <br /> Jo� s�� �vn�ss: �Z G v��� 'hvRC. /�� <br /> Occupancy Types ��_Residential Commercial '- - <br /> �v:� .�ti � _ � <br /> �WNER'S NAMR: (l�Il� �(V� ' � i Phone: � z �_ �-f �� <br /> Mai�.a.ng Address: ' > C ty;__j`7'J-Q,e,� �� <br /> c <br /> CONTRAC`.['b�'S Nl1ME; r • � ��'n Bus. No. ! (,p�"LI�-I Z�{JSI�o <br /> Mailfng Address: � � ,� J City: ��,;��, �(� m S !1 j <br /> �r,t*:***:�*u*x�*� �***** ���� <br /> Demolition it plannecl by means of: manual disassembly �heavy equipment <br /> ^burn�ng (by fire department? <br /> Permi�s Issued: <br /> �# Burning I'ire Depar�ment <br /> � WeZl Abandonment <br /> zn xeturn for issuance of �aid i7emolition �ermit, the undersigned owner <br /> hereby aqrees as �oliows: <br /> l. The structure(s} shal]. be kep� enclased and/or secured un�il such tim� <br /> as demo3ition is compiete. <br /> 2. Demol�t�oi1 debris will be kep� off ac��oining property and/or the <br /> pub�i.c xights�of-way unless speca.f�.c pri�ar appraval. is ob�ain�d �.n <br /> writing for temporary use thezeo�. <br /> 3. Foundat�ons shall be completely removed from the ground. <br /> 4. AZ 1 demolition debris shal. l be compl.etelX dispased af o�£ sit� in <br /> accordance with aIl appl.�.cable PCA r�quirements. <br /> 5. water weils mus� be abandoned in accardanc� with State HeaZth <br /> Department regulations. <br /> 6. Inspection required when all debx�.s has been xem�ved, be�c�ze <br /> backfilling. <br /> 7. Wi�hfn 5 working days v� sup�rstruc�ure remova]. { a �inal. inspection <br /> shall be requested. The sitie shall be left clean and clear of aI. l <br /> debris, witr� any excava�ion �il.l.ed with eartih level wi�h �he adjacent <br /> ground eleva�ion (except when such excavation is to be used as part of <br /> a new bu�lding and such new building is actually under cons�ruction). <br /> � � � � 1 <br />