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O^, City of Oronolit, -b!! c USE ONLY % 0 Q� <br /> W <br /> P.O.Box 66 Date Receiv +.//� � Permit# O� / ��/�� <br /> 2750 Kelley Parkway _ <br /> Crystal Bay,MN 55323 Amount: s.J/. e-'' SAC Credit: <br /> (952)249-4600 <br /> a <br /> A- <br /> , <br /> Homeowner(s)Signed: ❑Yes <br /> Resolutions(if any)Signed:❑Yes ❑None Required <br /> H oZoning Disclosure Signed: ❑Yes 0 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 fXrCommercial <br /> Site Address: S%' -. Ai5 mak: CA d Ca-y',,A-a( 5 ay IZ.ad 5 <br /> Owner: kkkoA-( ,.pc 1 i Ad►., 'Oujn�t i Mailing Address: 39Ct S' + Si-wk <br /> City: ErF o_.J t Zip: 55101 - IQ '5 <br /> Phone: Email: <br /> Contractor/Applicant Information: :; part FOY (.51 - (AL- 16110 <br /> Contractor/App.: K�►, ' •' E ,) Contact Person: ,Br i r cL 'CYS1.;,c1� <br /> `J <br /> Address: 1 i 5 (\ .. `.rvc4 State License #: <br /> City: J c.4 Pa.,1 Zip: `c-Allo.---6 Expiration Date: <br /> Phone: (1)177) ^ L451.3ii,O0 Email: by u,.d ( K rniSi X(CJt,J"i ry), (G:1. <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 ❑ 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 />