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4 lc <br /> CITY OF ORONO APPLICATION FOR DEMOLITION PERMIT <br /> P.O. Box 66 (2750 Kelley Parkway) <br /> Crystal Bay, MN 55323 <br /> SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT <br /> General Instructions <br /> 1. You may be required to obtain other permits, i.e. well abandonmment, etc. <br /> 2. Work must not begin unless the permit card is available on the job site. <br /> 3. A 24 hour notice is required for all inspections. Call (612) 249-4600. <br /> JOB SITE ADDRESS: 2c N o O 2G}4-p�1Zt' <br /> Occupancy Type: ✓ Residential Commercial <br /> OWNER'S NAME: -/11 11-- 13E , Phone: 95L clog •210104 <br /> Mailing Address: 2-6 0.101,J0 D12.Ct-f-Pcrup ROAD City: X-ON <br /> CONTRACTOR'S NAME: 17C-t- D .oLLno 3 Bus.No.: <br /> Mailing Address: City: <br /> Demolition if planned by means of: manual disassembly <br /> v/ heavy equipment (f-IOJSE Wtom. M J J) <br /> Permits Issued: <br /> Well Abandonment ((ma,' U5Fee_ 1 5.�A...) e) <br /> In return for issuance of said Demolition Permit, the undersigned owner hereby agrees as follows: <br /> 1. The structure(s) shall be kept enclosed and/or secured until such time as demolition is <br /> complete. <br /> 2. Demolition debris will be kept off adjoining property and/or the public rights-of-way unless <br /> specific prior approval is obtained in writing for temporary use thereof. <br /> 3. Foundations shall be completely removed from the ground. <br /> 4. All demolition debris shall be completely disposed of off site in accordance with all <br /> applicable PCA requirements. <br /> 5. Water wells must be abandoned in accordance with State Health Department regulations. <br /> 6. Inspection required when all debris has been removed, before backfilling. <br />