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4. <br /> �O� City of Orono FOR TI' 'USE ONLY <br /> P.O. Box 66 Date Received:/�- � Permit#�/ —O � ,(� <br /> � 2750 Kelley Parkway <br /> Crystal Bay,MN 55323 Amount: $ SAC Credit: <br /> (952)249-460a <br /> y � Homeowner(s)Signed: ❑Yes <br /> E' �,� Resolutions(if any)Signed:�Yes ❑None Required <br /> `qkFSH pti�' Zonin�Disclosure Si ed: ❑Yes ❑None Re uired <br /> CITY OF ORONO - DEMOLITiON PERMIT <br /> (Atl permits must be approved by the Building Official and/or Zoning Department) <br /> Job Site / Owner Information: <br /> Type: �Residential ❑ Commercial <br /> Site Address: "I 3 d �Gi r�-el'tU�OD� �G � �ron O <br /> Owner: �irK t l�am meor� Mailing Address: a�"¢�,5 /�ap�L IQic��L � <br /> T- <br /> C�ty: ..S'horewooc� zip: 5 S 33 1 <br /> Phone: �I Sa — 9 �4' - g4oa Email: �p K /Ytoor� 8 (�Lp��or� <br /> Contractor/Applicant Information: <br /> Contractor/App.:r��t�n ������ L�Contact Person: o�r1 Son <br /> Address: SOS r�et�n�"v �tef `� State License#: �l'i� 8'(9'8'S <br /> City: o urt Zip: 5S3 6� Expiration Date: .3 3 I 2�� <br /> Phone: _�S 2�' ��.3 — .5.3 4l� Email: q�or/�t� � �fs_�S'or���, Con7 <br /> SPEC1i4L CONDITIONS 8�'HOLD H�4RMLESS-A�GREEfiAENT <br /> General Instructions: <br /> 1. You may be required to obtain other permits, i.e.: well abandonment, sewer, etc. <br /> Z. 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 con#rol measures in <br /> accordance with Chapter 79, Construction Site Runoff Control. <br /> 3. 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. <br />