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OCity. of Orono o c,�USE ONLY <br /> P.O.Box 66 Date Receivedr!� /I /(� Permit it ��6,-6046 <br /> Q 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ l• DI' SAC Credit: <br /> (952)249-4600 y <br /> Homeowner(s)Signed: ❑Yes <br /> �E Resolutions(if any)Signed:❑Yes ❑None Required <br /> 4��$HOZoning Disclosure Signed: 0 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 /> Type: Residential ❑ Commercial <br /> Site Address: 558-s Oreik -1 Pitill- aS <br /> Owner: t;_ c. 4. Mailing Address: 555 Ot.6,42I-) -iiiitt Q.eht) <br /> City: Cleo in Q Zip: <br /> Phone: 163,22/2 -'1St Email: <br /> Contractor/Applicant it formation <br /> Contractor/App.: y ,,._ ,�.�-�_ Contact Person: ASY‘ tL11. <br /> Address: L'ivrc. i (etState License#: 1 ESc/�j <br /> City: Bictln t Zip: 5-. 1q1- Expiration Date: 03p/1'Z <br /> Phone: '7(3 7k'O—ZR4-fy Email: jrnc .0, k-Scpha mGS.rrcw, <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 pd 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 />