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t bt <br /> O�r City of Orono Fp$,CITY SE ONLY�/� <br /> P.O.Box 66 Date Received://'oS,7/.7 Permit#Y61Y15_41•s� <br /> VO 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ ,iV SAC Credit: <br /> (952)249-4600P <br /> A <br /> Homeowner(s)Signed: ?4417,C d Po-1 b2 <br /> (; Resolutions(if any)Signed:0 Yes 0 None Required `� �C <br /> /�1cp Ho'- Zoning Disclosure Signed: 0 Yes 0 None Required Z J <br /> fc <br /> • all <br /> .. Upl -t <br /> CITY OF ORONO - DEMOLITION PERMIT <br /> (All permits must be approved by the Building Official and/or Zoning Department) Etryuk4(. J (r Z(1—15 <br /> Job Site/ Owner Information: <br /> Type: ErResidential ❑ Commercial <br /> Site Address: 1 I O O-ervv Orcilwl Kid <br /> Owner: v,h.. S1✓ «O ¢" 17iq��w-° Mailing Address: 1(990 USO p/ As <br /> City: MG 1 G`'cwe Zip: 6513/1 <br /> Phone:9l a - S6 —S/(oo Email `I J"1' iCUNel Q3 nhcad.-,(J e( <br /> Contractor/Applicant Information: <br /> Contractor/App.: KR 0--- <br /> ( erc Contact Person: (� V—��6-4-e <br /> Address: /( 6 0 4 a /V a State License#: <br /> City: M" U • Zip: Cg-3i1 Expiration Date: <br /> Phone: 1Q/ -c&SO cic,,o Email: V l reJC0<J Co✓t4Ca-ii.APe/- <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 />