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OW <br /> City of Orono FOR CITY USE ONLY C <br /> P.O.Box 66 Date Received: i - 3 110 Permit ONLY, <br /> ((C^ t <br /> 2750 Kelley Parkway �7 C� <br /> Crystal Bay,MN 55323 i)i_ C k– Amount: $ /r3` SAC Credit: N`� �� -7" i. L <br /> (952)249-4600 I�,�3 cl <br /> Zr Homeowner(s)Signed: 0 Yes <br /> .,...._ rr_=/ ma ' Resolutions(if any)Signed:❑Yes ❑None Required <br /> Zoning Disclosure Signed: ❑Yes ❑None Required Zgi(v <br /> upecakti ygivd <br /> CITY OF ORONO - DEMOLITION PERMIT eJVW inwiT <br /> (All permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: <br /> Type: g Residential ❑ Commercial <br /> Site Address: 1 (,O Orckarc, Park road <br /> Owner: Fpj-YjCh.Mu\InvDoi f`TphAi0rri- Mailing Address: 4118 I-faIl9rth Lk) <br /> City: e Cc.IQ 1s I or Zip: 5533 I <br /> Phone: (60149 -- (054+ Email: . <br /> itU i tr1P1 fawn ilNrPOi I tow <br /> Contractor/Applicant Information: <br /> Contractor/App.: Ca rI S 6)1 D h s trus f 1'Vh Contact Person: Wa.CALU2diaeL11 <br /> Address: p612_15 Sf• 5 w State License#: 0 <br /> b� toZip: 553/3 <br /> City: �a Expiration Date: <br /> Ly . <br /> Phone: Wt.- 5L05-- ( I tido. Email: V <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT V <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 15 —(n Zk <br /> 150784 �1/ <br />