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a <br /> �OA, City of Orono _ ^ R TY USE ONLY G <br /> `V P.O. Box 66 Iry Date Received: Permit# <br /> 0 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 �1 Amount: $ SAC Credit: <br /> (952)249-4600 ��� <br /> Homeowner(s)Signed: ❑Yes <br /> deo Resolutions(if any)Signed:❑Yes ❑None Required <br /> `gkFSHO'� L 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: ❑ Residential Commercial <br /> Site Address: ek� <br /> Owner: ( PI&I O S001061 Mailing Address: <br /> City: IN olaz Zip: <br /> Phone: Email: <br /> Contractor/Applicant Information: <br /> Contractor/App.: -Ji ReA wq o - /1( Atcontact Person: C c� <br /> J <br /> Address: ` + State License#: <br /> City: �/h _ Zip: Expiration Date: <br /> Phone: Email: t4P--N 9&d-Q ltoLmell &!�JPA <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 DisassemblyrVr 1164, <br /> 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 <br /> 150784 <br />