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f � <br /> q i�C:��� <br /> �-�''�- �_S-D C� <br /> r <br /> CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT <br /> P.O. Box 66 (2750 Kelley Parkway) <br /> Crystal Bay, MN 55323 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e. well abandonment, etc. <br /> 2. Work must not begin unless the permit card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call (952) 249-4600. <br /> JOB SITE ADDRESS: 4209 North Shore Dr Mound Mn 55364 <br /> Occupancy Type: ✓ Residential Commercial <br /> OWNER'S NAME: �''ll'a"'T'tier Phone:�61z>sa3-sa3a <br /> MaI�1ri�Tf�ddCeSS: 2184 Shadywood Rd Cjty: Wayzata <br /> CONTRACTOR'S NAME: '�'a'S�f�c= Bus.No.: <br /> Mailing Address: City: <br /> Uemolition if planned by means of: manual disassembly <br /> ✓ heavy equipment <br /> Permits Issued: <br /> # ✓ Well Abandonment <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as follows: <br /> 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> complete. <br /> 2. Demolition debris will be kept off adjoining property and/or the public rights-of-way unless <br /> specific prior approval is obtained in writing for temporary use thereof. <br /> 3. Foundations shall be campletely removed from the ground. <br /> 4. All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health Department regulations. <br /> 6. Sewer and water must be disconnected at the services at the street by qualified contractors. <br /> 7. Inspection required when all debris has been removed, before backfilling. <br />