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City of Orono FOR CITY USE ONLY <br /> VLO ,/�\ P.O.Box 66 Date Received:^/►IS Permit#Igalif(LQk�) <br /> O \ 2750 Kelley Parkway <br /> f� 1 Crystal Bay,MN 55323 Amount: $747,4p SAC Credit: <br /> (952)249-4600 <br /> 1 h / Homeowner(s)Signed: ❑Yes <br /> ",r �� Resolutions(if any)Signed:0 Yes 0 None Required <br /> NSR, t S HOS@ Zoning 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 /> Job Site/Owner Information: <br /> Type: 0 Residential ❑ Commercial <br /> E -�h <br /> Site Address: � � 5- s Qy� t-* LV=. L <br /> k - <br /> AQ�c \ � Mailing Address: --?g- W +h AL\ ( v) "C? <br /> City: lci)c1\O`--t 11^1 Zip: e 41 <br /> -1 \ <br /> Phone: \ _'(U ` 3� -I Email c�JYI+AL� C�g 2\Vne k-40 M Q Cal <br /> Contractor t Applicant Information <br /> Contractor/App.: 0--L-KB \ Q Contact Person: QC)MA n 7_h ( <br /> (�J r <br /> Address: C k \PV\ Y" ,9 State License#: BC 6 cO' 2-3 <br /> City: ky(Y\ -k Zip:CS-`t`"1 1 Expiration Date: <br /> Phone: C S \ 2-70 '3 I 9 1 Email:CCI.APC...\ .'" C(..12:. MC k--t OM e.COM <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 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 />