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City of Orono FOR CIT USE ONLY <br /> \ P.O.Box 66 Date Receivedfj-ZLL Permit# -1„ <br /> D/y-Ot 4' <br /> \ 2750 Kelley Parkway ��QQ f <br /> 1 \ Crystal Bay,MN 55323 <br /> (952)249-4600 Amount: $ SAC Credit: No A o Q <br /> Homeowner(s)Signed: ❑Yes <br /> Resolutions(if any)Signed:❑Yes 0 None Required <br /> th FS Nod t- 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: N Residential ❑ Commercial <br /> Site Address: 23 L- S[-I A PI WOOD (ZD <br /> Owner: Jo ei''f{* I1.7 i,(.t ik M C C,g/gi railing Address: 2 3 lit SI,ZCkfin Vvoc'd <br /> Y <br /> Cit : 0120 No Zip: �s � <br /> Phone: x.50`7 - I ` b Email: UA/1C C-t1 gby 2_ 74)61y)/1_ 1 L< (Ain <br /> Contractor/Applicant Information:, <br /> Toceph <br /> Contracts /App.: LCL IA-int 1C CAA.i7( Contact Person: La.A. 21 M C (i,(,thel y <br /> 1. 1.O (wOvd kd <br /> Address: �� �► State License#: <br /> City: Q r iTy T _ Zip: 55301) Expiration Date: <br /> Phone: ZS I- Jin to Email: L C'CA-iU(..Oy Z ;) L , Cwv) <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:I 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 <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 />