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�O� City of Orono F�QR CITY USE ONLY <br /> P.O.Box 66 Date Received: y-/O- Pennit# �J"6d � <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $_�� SAC Credit: <br /> (952}249-4600 <br /> a � <br /> y� ,� Homeowner(s)Signed: ❑Yes <br /> (,� Resolutions(if any)Signed:Q Yes ❑None Required <br /> !"9KE5 H p��' Zonin Disclosure Si ed: ❑Yes ❑None Re uired <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: ❑ Residential ❑ Commercial <br /> Site Address: � � � C�J X-t—�J' Z, � �� <br /> Owner: �,��Z j�� [�'�2� Mailing Address: ��1� �b� Q0� <br /> c�ty: c�TZ�+� c� z�p: �5 3 S(v <br /> Home Phone: �— Alternate Phone: (C�Z'��� - `7 �5 � <br /> Contractor/Applicant Information: <br /> Contractor/App.: �Tf-�,N1�-S • z� ��S Contact Person: 7D� ,L� `�� <br /> Address: Zc�7'3 �nJ�'�tZA�'A- '3c.��D 6J �� State License #: 8�'%Z�lS�`� <br /> City: �K�j Lr¢k-�- Zip: �35(v Expiration Date: 3--3i — Z��T <br /> � Phone: 97�-'�7 s��,777 Altemate Phone: (�/Z�7S`7' — �G��� <br /> . SPECIAL CCINDITIONS & 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: ❑ 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 <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 /> 3. Submit a $2,500 escrow and an escrow agreement signed by the property owner. <br /> 4. Keep all structure(s) endosed andlar secured until such time as demolition is complete. <br />