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= (..-)r- IAA.t3 0-�wz:f `i r, !tel 1-. <br /> s <br /> ii Von2- <br /> lit�� City of Orono F R CITY USE ONLY <br /> P.O.Box 66 Date Received: 3 Ji i I 1 Permit# 2017— G-i <br /> 2750 Kelley Parkway l - <br /> Crystal Bay,MN 55323 Amount: $ ��dit:'r ' iS <br /> (952)249-4600 V U' •" <br /> -- k..; <br /> ` Homeowner(s)Signed: ❑Yes <br /> F �� Resolutions(if any)Signed:❑Yes ❑None Required <br /> `lKEs H Oitt Zoning Disclosure Signed: ❑Yes 0 None Required <br /> (Y 74( E <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 ❑ Commercial <br /> Site Address: 6E5 C) Vqkc 4 &,rc_ 'Kd <br /> Owner: ;& 4, ,rc� VI/lalai/ Mailing Address: ,&. 1'Par . 3 <br /> City: CA(ZtMO Zip: <br /> Phone: -14,3 "2c-{2-L/gFrI Email: <br /> Contractor/Applicant Information: <br /> Contractor/App.: pyo (., Contact Person: getmite <br /> Address: 9/150 t -.y, dfe_ (-. nE State License #: /g/q <br /> City: ktNett--- Zip: 51/4/9 Expiration Date: 3-/7 <br /> Phone: 163-7E6-Z6/yq Email:. 10711 1t herrne6. (��y,� <br /> ( q9-f') <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 SKI Heavy Equipment ❑ Other <br /> Permit(s) Issued: ❑ r Risconne�ctiioon-1C1 gWell Abandonment# <br /> *I__, <br /> In return for issua ce 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 IO —5 ICI <br /> 150784 <br />