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A, City of Orono FOR CITY USE ONLY �d WC-1 <br /> �Of V P.O.Box 66 Date Receive4b45:( Permit# �/3 <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-4600 <br /> Homeowner(s)Signed: ❑Yes <br /> <`' Resolutions(if any)Signed:❑Yes ❑None Required <br /> `gkf5 Ho�� Zoning Disclosure Signed: ❑Yes ❑None Required <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: 1� Residential ❑ Commercial <br /> Site Address: <br /> Owner: U � NAA DPW P1 NCtj )E:a Mailing Address: �Z '3TJAfvIAP-Az K IOR <br /> City: Zip: ��� 5� <br /> Phone: Lcf6--3,36- 12-1 6 Email: b ,-%A e r! e) I ( . tom <br /> Contractor/Applicant Information: <br /> Contractor/App.:_b9,A b IARC-r,iPEe Contact Person: 3�p0 �1A�P%tiitl� <br /> Address: '2113u 'I AeAhtLAzK 1P X State License#: <br /> City: LoPJk-, Lfi}PC Zip: $56s Expiration Date: -- <br /> Phone: -335 - ('2.1`� Email: 6(�114 co" <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 <br /> issued. <br /> Demolition by means of: ",Manual Disassembly ❑ Heavy Equipment ❑ Other <br /> Permit(s) Issued: '0-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 <br /> structures are to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Site Runoff Control. <br /> 3. Submit a copy of permit approval from the Minnehaha Creek Watershed District (MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the MCWD or <br /> documentation stating permit(s) are not required. <br />