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i <br /> . �O�T City of Orono �I SE ONLY <br /> �y P.O.Box 66 Date Received�U ermit# S,e�b � �� <br /> � 2750 Kelley Parkway j <br /> Crystal Bay, MN 55323 Amount: $JCf •r� SAC Credit: <br /> (952)249-4600 <br /> y � Homeowner(s)Signed: ❑Yes <br /> � �,� Resolutions(if any)Signed:❑Yes ❑None Required <br /> ��KESH��� Zonin Disclosure Si ned: ❑Yes ❑None Re uired <br /> u��a �sc.��v�r ��� r�,��d.. <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> °� <br /> (All peRnits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Informa#ion: <br /> Type: �esidential ❑ Commercial <br /> Site Address: �3 �v 3 ni '�'� ��.or� �,.�l.�c <br /> Owner: �o� �cs 5�e-►� Mailing Address: ��, <br /> City: 6 r a �� Zip: �s � � � <br /> Phone: ��a '� l6— S'"g �� Email: �VeS��--,'�����.9�v�►-��1_ Co•-.� <br /> Contractor!Applicant Information: <br /> Contractor/App.: ��t�-�e s � �o�w� c� Contact Person: ��� ��� <br /> Address: 3 Y w��-eY SEve�� Si�c,/� State License#: �C 6� 7 �s �, <br /> City: ��c�s�e✓ Zip: s�3 �� Expiration Date: / <br /> Phone: �'�,..f�-- �7d � (�/ � Email: .S�P���y,.s.���PoT �ti�%.G�.S.Ca� <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. <br /> 4. Sewer must b�discontinued at the City service by qualified contractor before demo permit is issued. <br /> Demolition by means of: � Manual Disassembly ❑ Heav Equipment ❑ Other <br /> Permit(s) Is�� Sewer Disconnection ❑ Well n ment# <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees 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 sketch showing proposed erosion control measures in accordance with <br /> Chapter 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. A`� <br /> �v <br /> Form Last Updated: July 2015 1 _ � �� �i��� �� ` ���� � -1 _ <br /> 150784 1i A ��l`�cll�� <br />