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I' <br /> RECEIVED • <br /> 140 APPICA'n 014 <br /> City of Orono MAY 20 2016USE ONLY 411601) <br /> 2P.O <br /> .Box 66y Parkway <br /> Date Receive //p Permit <br /> Crystal Bay,MN 55323 ��/OF ORONO <br /> Amount: $ rik <br /> 6 <br /> (652)249-4600 V�� " AC Credit: 3101 <br /> Homeowner(s)Signed: ° �, , <br /> der �, Resolutions(if any)Signed:°Yes 0 None R ,!\,t Mf <br /> �'1' lr <br /> %I's H DQE 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: ,Residential 0 Commercial <br /> Site Address: 13 8O 0 f Ono In <br /> Owner: LU ke B`)+n iC K Mailing Address: 30"8 Emerson / �e S <br /> City: J r 1intleleol1s Zip: SS t108 <br /> Phone: Email: <br /> Contractor/Applicant Informations:,� l ,VI <br /> Contractor/App.: &01)i'l' *" So <br /> . n3 Contact Person: (C rl� FP( <br /> Address: IN()) Co Rd 3 State License#: <br /> City: [JO?hal5 Zip: SS 3L13 Expiration Date: <br /> Phone: 9s1- 93) C' (;i Email: 130114an°Sorb C5' ntn. Curl <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: 0 Manual Disassembly XHeavy Equipment 0 Other <br /> Permit(s)Issued: 0 Sewer Disconnection 0 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 /> 1[MOA <br />