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O City of Orono Fo CIT SE ONLY �-j <br /> � � P.O.Box 66 Date Received: ermit#p�/�— �D✓ <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: ,A� SAC Credit: H U � .�ofL <br /> , � � (952)249-4600 ��/�� <br /> y ` Homeowner(s)Signed: ❑Yes �� <br /> <`' �, Resolutions(if any)Signed:❑Yes ❑None Required <br /> t9kPS H��� Zonin Disclosure Si ed: ❑Yes ❑None Re u'ued <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All pertnits must be approved by the Building Official and/or Zonin�epartment) <br /> Job Site / Owner Information: Gi'�` <br /> ���� �� <br /> Type: �Residentiai ❑ Commercial <br /> Site Address: ��I��' / V `Sh�r�. ,�� <br /> Owner. 1��h C���en Mailing Address: ���7� / If �n`�� �� <br /> c�ty: C�i�o�'�� zip: ��S3�► I <br /> Phone: ' � Email: b�n� �I�h��i��j��(�C,i91'� , �,0�1�1 <br /> Contractor/Applicant Information: <br /> -,,,� r <br /> Contractor/App.: t.x��►� � �D��� Contact Person: ��U11 ���� <br /> Address: � ����� � Ru � State License#: <br /> p , <br /> City: � � 1�1�15 Zip: 5����,� Expiration Date: <br /> Phone: 6��-���� 6�� � Email: ���I� a f���v�� �.` �n�Co 1�1 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <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. . �1 � <br /> 4. Sewer must be discontinued at the City service by qualified contractor before demo permit is issued. �' <br /> � �'�y <br /> Demolition by r��eans of: ❑ Manual Disassembly ❑ Heavy Equipment ❑ Other ``��o{�11 <br /> Permit(s) Issued:�Sewer Disconnection �] Well Abandonment# ��, � � <br /> S� � <br /> In return for issua ce o�said L'jemolition Permit, the undersigned owner hereby ag ees to: <br /> 1. Submit a survey, aerial photo or sketch showing all structures on the property. Note which structures are <br /> to be demolished. <br /> 2. Submit a survey, aerial photo or s�etch showing proposed erosion control measures in accordance with <br /> Chapfer 79, Construction Site Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The City will <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 /> Form Last Updated: July 2015 �I� �3l� <br /> 150784 <br />