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CITY 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: `125" 0lotLor►�9 Lake 1Paad l l-/ayrt7ta AL1�I/ <br /> Occupancy Type: X Residential Co3hmercial <br /> OWNER'S NAME: .Darr e 1/ 4 2,ul to rso h Phone: 0S2) '�7.3 — 19zztz <br /> Mailing Address: 9 2 O W, way Z f a E1 k-A, City: Q y>a <br /> CONTRACTOR'S NAME: y-PN cc /4r T Bus.No.: (32o)s70 <br /> Mailing Address: 2 33 2 i t i 1/. City: L-ctke <br /> Demolition if planned by means of: X manual disassembly <br /> heavy equipment <br /> Permits Issued: 13 0 1 <br /> # H 0 Z ZWell 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 />