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O City of Orono FO;t C USE ONLY <br /> P.O.Box 66 Date Received: 1 aZ7 Permit#„jDI7�Ql(�/g� <br /> �� 2750 Kelley Parkway /��" <br /> Crystal Bay,MN 55323 Amount: $ /w% SAC Credit: <br /> (952)249-4600 <br /> A <br /> 1tiiito.,4• 1 /5105 Homeowners)Signed: 0 Yes <br /> G Resolutions(if any) Signed:❑Yes 0 None Required <br /> kEsH o' Zoning Disclosure Signed: 0 Yes 0 None Required <br /> e eJot ) per_ t -/.2-7117 <br /> CITY OF ORONO - DEMOLITION PERMIT a41-- 0111107 <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site/Owner Information: <br /> Type: 1 Residential E Commercial <br /> Site Address: 3 i C A.)Av)sunF C---- <br /> Owner: <br /> Owner: (:RAc-e Q.L1. (7 k ,4\4,0,__) Mailing Address: 3Z'6tp )l-/#,,,ze, L,.,E, <br /> City: biZa,v Zip: <br /> Phone: col L- 99 ii --19 bei Email: cy=t-Livr,wr;�c,Q(AI(0( Nw.c.:).c.a, , <br /> Contractor/Applicant Information: l <br /> Contractor/App.: (___,..1 t_iwc. C u..A2�4..:br.J Contact Person: 1L..1A,.>! -- - <br /> Address: S 3 G kc,—.i B-c State License#: )3 L—L-12cit6 <br /> City: ('s.A Zip: /A.•J Expiration Date: 3 131 1 I <br /> Phone: L'S )-S1 - 34.1-2._ Email: v�c.u. c �l,J:.S2 %-vv, v.i+-4--4:ori. �« <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: ❑ Manual Disassembly [Heavy Equipment El Other <br /> Permit(s) Issued: Sewer Disconnection ID 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 cl -(i L5 <br /> 150784 <br />