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1 <br /> , � <br /> . � � 6 j �'r�tt <br /> �O^T City of Orono FO�2 CTI'Y USE ONLY <br /> 1 V P.O. Box 66 Date Received:`�/73� Permit# �� /� <br /> � 2750 Kelley Parkway <br /> Crystal Bay, MN 55323 Amount: $�L� SAC Credit:�� � <br /> (952)249-4600 /' _�GCy�_\ <br /> y � Homeowner(s)Signed: ❑Yes � T�� J <br /> �' �,� Resolutions(if any)Signed:�Yes ❑None Required <br /> l Zonin Disclosure Si ned: ❑Yes <br /> '�kES H��� ❑None Re uired <br /> ��9(�S`� ����� <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: Zd )`'r j��.v��w�t� \%��,,,� <br /> / � 1 <br /> Owner: ``)�.� 3�b�^�� `�,�� Mailing Address: SAfV�SL <br /> City: O�Jd�o Zip: .��j°l( <br /> Phone: �l��-' J�1� '-��7� Email: \�`�1�.����� °1�(ltii�.(d✓V� <br /> Contractor!Applicant Information: �J um`n' e� K'�f� � 9"�''� <br /> Contractor/App.:�a�ti r��,�v�e,� V�1.ti�,�r,� Contact Persorr. -� ��►� <br /> Address: �� ��� �`"����S � �' ✓�� State License#: L.,3 d� .S�b SS� <br /> City: av��� Zip: Sr�b 3 Expiration Date: b�� �1 �� <br /> Phone: ��� - �7� J G� �1 S Email: �l�l <br /> SP'ECIAL CONDITiONS'& HflLD HARMLESS AGREEMENT <br /> General I nstructions: <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 /> N q4. 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 Sife 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. �, r ,�_ �,,,,,l� <br /> N� «.i <br /> Form Last Updated.� July 2015 <br /> 150784 <br />