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City of Orono FOR TY SE ONLY <br /> W <br /> Date Received:!// � Pernvt# 60J2750 Kelley ParkwayCrystal Bay,MN 55323 Amount: $/ SAC Credit: <br /> (952)249-4600Homeowner(s)Signed: ❑Yes <br /> C ,i Resolutions(if any)Signed:❑Yes ❑None Required <br /> H oVP Oh'^A t Zoning Disclosure Signed: 0 Yes 0 None Required <br /> tV <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/ Owner Information: <br /> Type: RResidential ❑ Commercial <br /> e <br /> Site Address: 7.4)6 C Civ-Sc-0 Cd ;NA- `;-. • <br /> Owner: `i.:)0-�& 9 Li Mailing Address: S`t'd <br /> • <br /> y l'�� <br /> Cit ` /Oco.�a Zip: /';' <br /> Phone: CA S2- ' 5`l`l - l") t`f Email: o v�_-( M 1,c \L frk Sn . <br /> Contractor/Applicant Information f <br /> Contractor/App.: ��0, 8 o--, --... 0,...,0s Contact Person: ,......\61,\,-. vu-,,.� <br /> Address: St S l ),Ac-L-,.), ¶k . State License#: ' CS-A\`l.c,1 <br /> City: )k a rS Zip: SS-39) Expiration Date: 3("/3% /‘ <br /> Phone: °'152 - --1–( 1 - 563 Email: ,iV\•'1,\ J P 90 r- - rdk-e- <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 be discontinued at the City service by qualified contractor before demo permit Is issued. <br /> Demolition by means of: 0 Manual Disassembly a-kleavy Equipment 0 Other <br /> Permit(s)Issued: 0 Sewer Disconnection 0 Well Abandonment# <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. <br /> Form Last Updated: July 2015 1 'to <br /> 150784 JJJ <br />