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A • <br /> •T <br /> O�'`}. City of Orono s TY SEt7�`LY D <br /> /-� P.O.box 66 Date Receive moi; } writ#7�Q/ 3 93 <br /> 0 2750 Kelley Parkway a <br /> Crystal Bay,MN 55323 Amount: $ ' SAC Credit: <br /> (952)249-4600 <br /> -.4 G' Homeowncr(s)Signed: 0 Yes <br /> {,, Resolutions(Warty)Signed:0 Yes 0 None Required <br /> `'I�iES " 7_onin_Disclosure Si_ned: ❑Yes ❑None Re+uired <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (Ali permits must be approved by the Building Official and/or Zoning Department) <br /> Job.Site L Owner Information <br /> Type: NI Residential ❑Commercial <br /> Site Address k ei 0 r_orJ,. Vic.t.1/41)(1-: Q . <br /> Owner: --X tam tt. L)( Lus- Mailing Address: cymrj`� <br /> City: (N-)9_-c,J 0 Zip: 4~;S3`) <br /> Phone: c\` 2 GJ')`t • <br /> Email: Q Q. t) c-(Ln r,*s e.0 w e <br /> J <br /> Contractor;/Applicant Information, ; <br /> Contractor/App.: 04--'--)z:-.) �4r.V"0 - G_s-c.. Contact Person: C ea 41)^s� rCAr— <br /> Address: 'it ti`l l'AA,.-, �'` ��� `� �cLState License#: )C- ?)\°1( <br /> ' <br /> �Cit : m,,..c t.nt,,, Zip: ' Expiration Date: 3/3 t ji C <br /> Phone: 44:5 ' 3k 17. Email: Se>In V l .. t3)sec�d",— y rrk,e S- <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 <br /> issued. �-,! ' <br /> Demolition by means of: CI Manual Disassembly �w-leavy Equipment ❑Other <br /> Perm t(s)Issued: El Sewer Disconnection ❑Well Abandonment# /�. <br /> In re urn 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 <br /> structures are to be demolished. <br /> 2. Submit a survey, aerial photo or sketch showing proposed erosion control measures in <br /> accordance with Chapter 79, Construction Site Runoff Control, <br /> a. Submit a copy of permit approval from the Minnehaha Creek Watershed District(MCWD). The <br /> City will not issue a demolition permit without a copy of the permit(s) from the MCWD or <br /> documentation stating permit(s)are not required. j <br /> I <br />