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r <br /> 8ZLO City of Orono FOR IIY USE ONLY <br /> P.O.Box 66 Date Received: F._0272 <br /> Permit# 2t Ok"_O D 4,, <br /> 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: /l!C� ��_c� <br /> (952)249-4600 ,�o� jfp <br /> .a <br /> y Homeowner(s)Signed: ❑Yes <br /> �/, 0'4. Resolutions(if any)Signed:❑Yes 0 None Required <br /> l E H O�� 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: fn,Residenntial ❑ Commercial <br /> Site Address: Lk Ovorn o 6.-c ttet4-c/ RI N <br /> ' <br /> Owner: <br /> IItvrd 4 7K-Ga 1( fil-1,k. Mailing Address: <br /> City: d 1iD Pt ° / M N Zip: 55-3, <br /> Phone: (I7. 14(#.1 . 239 S Email: d'A vi'At• kk8..'"i°• e1•.114:" I• ca <br /> Contractor/Applicant Information: <br /> Contractor/App.: Contact Person: <br /> Address: State License#: <br /> City: Zip: Expiration Date: <br /> Phone: Email: <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 inspeiions. Call (952) 249-4600. <br /> 4. Sewer must be discontinued at the City seFRce by qualified contractor before demo permit is issued. <br /> Eh <br /> Demolition by means of: IN 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 />