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A' City of Orono 4),,/f_T USEONLY�Of VPO.Box 66 Date Recei Permit#�/7-4/J/1) <br /> 0 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $7‘9•117 SAC Credit: <br /> (952)249-4600 <br /> .� �, <br /> Homeowner(s)Signed: ❑Yes <br /> yF �� Resolutions(if any)Signed:0 Yes 0 None Required <br /> �gkESHOR� Zoning Disclosure Signed: 0 Yes 0 None Required <br /> CITY OF ORONO - DEMOLITION PERMIT 0 -( - /11 <br /> (All permits must be approved by the Building Official and/or Zoning Department) _,,,e./�' <br /> Cliit <br /> Job Site I Owner Information: W <br /> Type: [g] Residential J E] Commercial <br /> Site Address: Z(v Z 5 )61/j 4 YL ZYbvtO <br /> Owner: I(P.UI I<LyvtOY1,t Mailing Address: Z(v Z s J/ L i'7ve_ <br /> City: inOnD Zip: 5533i <br /> Phone: (0 I Z. ?(oO 42-(c (c. Email: J I ekt @ -Q'.a (C.S S? ati , 66 <br /> Contractor tApplicant Information: <br /> Contractor/App.: d S S1t vO- - £o. I etc_ Contact Person: •-r-retc-ei U4s� 1 <br /> Address: 1 ID o ketkvw r.& rkt VE State License#: J <br /> City: 1Q,R01/e- Zip: SS 3L1 I Expiration Date: <br /> • <br /> Phone: `7(,'3 Ltl' ' D 30 Email: i AA-0,191 S -e t„)Gc.A-� I Cowin <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 DA Heavy Equipment ❑ Other <br /> Permit(s) Issued: ❑ Sewer Disconnection ❑ 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 ci <br /> 150784 <br />