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J• <br /> 1 <br /> S <br /> CTI'Y 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 abandonmment, 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(612)249-4600. <br /> JOB SITE ADDRESS: �J �� Az Z)A - <br /> Occupancy Type: X Residential Commercial <br /> OWNER'S NAME: ISS �S S Phone: Sar Y71- 01577 <br /> Mailing Address: 01® City: 5DA t iM W <br /> CONTRACTOR' NAME: ,S-l'OnG44)®0d JUd i�j Bus.No.: Sot - LIT- DrY <br /> LI <br /> Mailing Address: _ City:"S-AeiAT AAL ml . <br /> Demolition if planned by means of: manual disassembly 5-e3 Al <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 completely 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. Inspection required when all debris has been removed,before backfilling. <br />