HomeMy WebLinkAboutAll paperwork prior to demolition�
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' CITY of ORONO
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{� Post Office Box 66•Crystal Bay,Minnesota 55323•Municipal Offices
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� s _ � � On the North Shore of Lake Minnetonka
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j NOTICE OF DEMOLITION & ADDRESS CANCEI�LATION
� June 1, 1990
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� Due to the recent plat of Fox Bend, the residences have been
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razed at the following addresses within Orono:
Address Permit # Date Issued Permit Finaled
. 3020 Fox Street 2484 11/Ol 89 11 06 89
2960 Fox Street 2958 06/O1/90
� These addresses wi 11 no longer be used as the property has
been incorporated within Sussex Road addresses. Please change
' your records accordingly.
, cc: Owner: Nina Wildman, 745 Spring Hill Road, Wayzata
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Post Office, Fire Department, School District, Orono Police
; Department, Orono City Departments (Finance & Assessing) , NSP, NW
Bell or Contel, Hennepin County Sheriff, Hennepin County Dept of
Taxation, Minnegasco, NW Bell (Omaha office)
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� BUILDING&ZONING-473-7357 • ADMINISTRATION&FINANCE-473-7358 • PUBLIC WORKS-473-7359
"��' ASSFSSING FAX-473-0510
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STATF�.()F MINNI-:5f)TA Ok�.YAMiMlNT 04 MF:ALTH
I. I.nl ATI(lN UI WF LL , A1/NNFSOTA UNfQUE WEI.L NO. t. i �� � � �
o���irN��,. WA7ER WELL RECOflD � p
Jor warn somvR ,j. ( �
Minnc.ioto SfeN f[f/SM1 A.11l�.(IM �
T�iwns�ip Name � s ip umner Han�e Numher yec�l��n N�. I�r�a��lli�n J. YROYERTY OWNF;RS NAMk:
� �»�.� S` � w � S�i'� � 84i �i `�11�{'#� (///!��� / ���-
I>isi.nce and ec � fr��m Ho�J Intrrsec�i�ins��r Slrcel AJJress and('ily o!W�II Loc�liun Addresi � . ' I W
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Snow e,c�c�I��c.�ion nf ell in�ecli���griJ wllh"%." Skelch map ot we111Maiion. a.WF:LL DEPTH(completed) Da�e of Completion �
" i�� �-a�m�:�
_L_ - _' `_'_ " AJJili��n Name
ft.
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N - - - - -�- - E i❑c.ni<i����i aOke.r�u �Ond.�� io❑i>��
i i � tll�ick NumAer
} 2❑Hnl�nwtuJ 5❑Air 6�Bnred 11❑
' - - '- '` ��11.. Jf1w�"�+rY 6❑leifed 9�Ynwer Aueer
--. - --�-- 1
Lo1 Numher 6. USE
iC'��mrs��� ��v�nr s�vv�r �O i�do:„y
$
r--��.u—� :o�.�,e��,,,� SoM�����o.�
ao��mme.�,.�
3. FORMATIONLO(: C'OLOIt H�ItI1Nk:SSOF F�H�M TO
FOHMATIUN JOTeN Wrll 6�Air('�rndi�ioning 9❑
� y,�.,�, i.CASING HEIGHT: Above�Below HOLE UTAM
�},� ��„� �� � Z IODI.ck. aOThreadeJ
�_�
� 20(;alv. 5❑Welded Sur(�ce ft.
`•"+'� �� � �"'� 3�18siiC � DrWe Shoe? Ya_ No�
� �to � fl. Weighl ��.�� I�f./ft. �in.to_ft.
+�Is�y '6�1.i�t I4 25 ,�.�o ��. w<,�� ��,.,�.. —;�.�o—«.
in.to fl. WeiRhf IM./fl. _in.to_(f.
' ��� b� � � B. SCREEN �]� r open ole
Make� �"�'"^ from ft.ro h.
� IS��Z �8�.�1AF S� �S TYVe � Dia.
Slol/Gauze Length
�t k'ITTINGS�.
���1 red b 65 ,�r� se�ne�w«�� n.,oe n.
fl.and f1.
L�,, +�g �j��'y 9. STATIC WATtH LEVkL
�� P�V� lE+� i.LSJ R�' fl.❑helnw ❑ahm<� DaleMeasured �^��
v,r
� �� land surlace
� � � 10.PUMNING LEVEL(below land surfa<e)
�b fi.aher hrs.pumpin6 r�g.p.m.
�t f�.afler hrs.pumpin6 e.p.m.
I1.WI-:LLHk:AUCOMYLF:TION
��Pilless edaptar,m�nufacturer moAel
z❑ea. e��orr:<� �O At le�st 12"ebove grsde
12.WELL GROUTED?
��' l,�'es ❑No
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i[�or��crmc��� z❑er�������e 3❑
c�o�s m.«��.i o-om aa «..c�.va:.
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13.N�E`AR`E�6Ty 60URCE6 OF POSSIBLE CONTAMINATION
—�fe<t dircetion IYDe .
Weli disinfecteA vpon completwn'. Yes� N��O .
10. PUMP
- Dale inclelled�+� ❑Nol inslalled
ManufactureiY Name
�� �t�.�4f'�:�. -r
MoAel Numbtt HY�Volis ��
Length of dfop pipe � (1.capuilY B.p.m.
Material o!drop D�D� �^���
7ype: �wynmcrcinle 3�L.S.Turbine S�Rrc�prucalin`
]Qlrl aOc�ro���r�e,i 6❑ �
Use a second sheet,if needed i6.WA7ER wELL CONTRAC70R'S CERTIFICATION
I5.REMARKS.ELEVATION,SOURCE OF DATA.atc.
'Ihis well was drilled under my jurisdiction and Ihia r<Don u true�o
the besl of my knowledge and belief.
� � V�i 6i��7�'i
Ltcrnser Businera Name Llcen+e No.
- .AdOress �+'�'V +�] :�: �) �+^� +�.Liif L'ii�eb
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Siened f ,/,.�.. ',:F /A��.. . .. . . Date
Aufhorized Representative
7'�ieic St�s n,c� t�`��� '
..p y -- � Name of Dri11H
�.-',.i L t.s,. ��P��l �� `� ('7 ?.y 5/74 30M
7/76 30M
'r` �� ,... . ...r.. ...�._. ., 7/78 30M
HE�01205-01 2/82 10M
CITY OF ORONO Date
ADDRESS Connected to
CODE SEPTIC SYSTEM INVENTORY CARD Municipal Sewer
Address ---'`��-.�.' f'�' :� �_ - Property I.D.Q�I'lI�7 Z-3 .�� C.��C'c'1 1 + WELL iATA
O Standard trench , L�'i 5 3'�-�-�.J � I
❑ Mound � o,
System t � i g p `� �"`�`: � '
ype Other i JL�! G%t-�Ly Le al Descri tion /rZ� " /� O �
Permit No. "' Date of permit ' %I�C�,� Installer � �° �I p
d
No. Bedrooms Garbage ,� �„ f
Building type �:C�1i�E��%L`c or GPD � �7=�' Laundry .k� Dishwasher Disposal � Y = I
� a �
SEPTIC TAN KS: Material ��fci� �:r�- t�S t-�-c Jc Capacity 1) � 2) "� � �C 'o
�, ` a
Proper outlet and inlet Baffles Liquid dept o RO level 1 3 �
' Q= �
1 � .� m
Height of ta�k bottom above water table Distance to rlearest bu ing �C� — � N m
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DRAINFIELD: Total length of lines Number of lines Trench width (,J
Y �
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Total trea ment ea (sq.ft.) eight of drainfie �oJ� ater ble ;?
1 U
Type of fil r mate ' Soil t e a `
� �.
y N
\ � _
Distance fro neares bldg. �'� � Tile size �' �-�' i�� Perc rate min/in ° �, a ,c
a p°' v
m >
U �0
Depth of fill o er drainfield Depth of rock over tile under tile � n �' "
:° E c �
p a Cj �
�OCATI ON
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INSPECTION RECORD PUMPOUT RECORD S�<ETCH
DATE COMPLIANCE DATE GALLONS _ � � _
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�,'-/'7-Fi2 /�=D s�irzF'oUn.lG Nc'Tt`� 2 t
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T.�}-�vKs' �� Lac��� �
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`1-Zs "�� �?�:� �cc:n-�c�n;s �t,�c�;� ti � -
� �.y"� w;�� ~�� I
Il- 9 t ibC >��RFl�C 1 Nu (�lC I�I1 �--- �
r/-//-_/r'f' /�/L�.S= =�4,C'iNL� L- ` � i
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Indude: 1) Well location �
2) Distance from house to ( �
septic tanks,dist.box, I '
and drainfield ' �
C- CONFORMING S-SUBSTANDARD N - NONCONFORMING 3) North arrowand road / �
`ox ��i��ET
On th.e North Shore of
Lakc N1i�l�aezonk.
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
� _ � � 1335 S. Brown Rd.
Crystal Bay, MN 55323
473-7357
OWNER ��cl�c��z'� Tl.,���i�t«<�-�-i ADDRESS �'���L�G Fz��C �,.Cv'�;t� L �—
�
PERMIT NO.'S. � DATES � f��'�L ' CONTRACTORS =
City Ordinance No. 210 requires that each on-site sewage treatme�t system in Orono be inspected on a regular basis.The on-site sewage
treatment system at the above address has been inspected and appears to fali into the category checked below.
(This is us, an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.Appears to be operating
properly.
�2 Does not meet all current City standards for new construction 11978 Code) but in most respects appears to be designed,
located, and constructed generally in accordance with previous codes. System appears to be functioning properly; no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design, construction, or location.Appears to be operating
adequately at this time, but has a relatively high potential for future problems. No major upgrsding of system is required at
this time.
� 4 System may or may not meet current City standards for design,construction or location, but is failing to properly treat and
dispose of the current input, and is endangering a water supply, or is a source of potlution to surface or groundwaters,or is
creati�g a safety hazard, or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
repiacement procedures. If drainfield replacement is necessary,soil testing will usually be required,and a design and site plan
must be submitted for review.Your contractor must obtain a permit before work is started.
SYSTEM CONDITION ( m Checked items may require your action)
Tank inspection indicates: ❑ Inspection pipe is located directly over tank baffle. (Does not
❑ Pumpout not needed at this time. give accurate measurement of solids accumulation.) If tanks
❑ Solids accumulation in tanks indicates they should be pump- have �ot been pumped out within the last three years, they
ed out this year to heip prevent future problems. should be pumped out now.
❑ Solids accumulation in tanks is at a critical level. Tanks Drainfaeld inspection indicates:
should be pumped out as soon as possible, L�Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. ❑ Drainfield is saturated and visibly discharging untreated
� I�spection risers missing—tanks could not be inspected. effluent to the surface. This condition may require replace-
� inspection risers (4" dia. pipe) must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. if tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. ❑ Drainfield extent and condition unknown.
SITE CHARACTERISTICS:
Limiting Site Factors Potential for System Failure Site Capabilities for
❑ Slope (depends on soil types,water Future Expansion
❑ Soil tabie,and system condition) � Adequate
❑ High water table �Low i. �Fair
�Lotsize I�'Medium 55�1'�`���� ���y` ��'Poor
❑ Lake,wetiand,or stream ❑ Nigh ❑ inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
COMMENTS: v����V" f`��('/'f^Cl� C�7L�Vi; VI�IIY' S�iJ�C�I'Yl �1Gt${�'j�t ��`-{q ��L'���1�(� �llr1['� ��1UL�
� „_
��r ���1 � ✓'._ �U _ i � �� � i F�c-1 �c � � � r'� - � ru.�S 'fc�- Givc-�c
, _..–
�G�:S�, �� r���'>�'t, ✓S
�2�E1.> �Z . I"C�U � ,��� '/i� q �,...
� Dat of Inspection Septic System In� e r
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that
this report does not guarantee or certify that an existing system will continue to function properly,but is merely an opinion of the adequacy
of the system under current co�ditions based on the available information.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/ Inspector's File GOLD COPY /Homeowner
On the North Shore o f
Lake Mi�z�zetonti
ON-SITE SEWAGE TREATMENT
INSPECTION REPORT � POST OFFICE BOX 66
� _ � � 1335 S. Brown Rd.
Crystal Bay, MN 55323
473-7357
�� � ����G I��'.� � .``���L-
OWNER IllcFffffs�U ��(f�A,'JIlA/�'1 ADDRESS
PERMIT NO.'S. � DATES ��� �"�' CONTRACTORS �
City Ordinance No. 210 requires that each on-site sewage treatment system in Orono be inspected on a regular basis.The on-site sewage
treatment system at the above address has been inspected and appears to fall into the category checked below.
(This is LJ an existing system ❑ new construction)
� � Meets or exceeds current City standards in all respects relating to design,construction,and location.Appears to be operating
properly,
� 2 Does not meet all current City standards for new construction (1978 Code) but in most respects appears to be designed,
located, and constructed generally in accordance with previous codes.System appears to be funciioning properly; no major
upgrading of the system is required at this time.
� 3 Does not meet current City standards in many respects relating to design, construction, or location.Appears to be operati�g
adequately at this time, but has a relatively high potential for future problems. No major upgrsding of system is required at
this time.
� 4 System may or may not meet current City standards for design, construction or location, but is failing to properly treat and
dispose of the current input, and is endangering a water supply, or is a source of pollution to surface or groundwaters,or is
creating a safety hazard, or is otherwise creating a public nuisance.Please contact the City Inspector to discuss system repair/
replacement procedures. If drainfield replacement is necessary, soil testing wili usually be required,and a design and site plan
must be submitted for review.Your contractor must obtain a permit before work is started.
SYSTEM CONDITION ( � Checked items may require your action)
Tank inspection indicates: ❑ Inspection pipe is located directly over tank baffle.(Does not
❑ Pumpout not needed at this time. give accurate measurement of solids accumulation.) If tanks
❑ Solids accumulation in tanks indicates they should be pump- have not been pumped out within the last three years, they
ed out this year to help prevent future problems, should be pumped out now.
❑ Solids accumulation in tanks is at a critical level. Tanks Drainfield inspection indicates:
should be pumped out as soon as possible. ❑ Drainfield is dry,no surfacing evident.
❑ System is discharging to surface. Tanks must be pumped ❑ Some evidence of surfacing,not critical yet.
within 48 hours to eliminate surface discharge. ❑ Drainfield is saturated and visibly discharging untreated
--B Inspection risers missing—tanks could not be inspected. effluent to the surface. This condition may require replace-
Inspection risers (4" dia. pipe) must be installed in each tank ment or additions to drainfield. Contact the City Inspector
at next pumpout. If tanks have not been pumped out within immediately.Repairs must be completed within 90 days.
the last three years,they should be pumped out now. —�7 Drainfield extent and condition unknown,
SITE CHARACTERISTICS:
Limiting Site Factors Potential for,System Failure Site Capabilities for
❑ Slope (depends on soil types,water Future Expansion
❑ Soil table,and system condition) ❑ Adequate
❑ High water table ❑ Low '-� Fair
—�7 Lot size --�] Medium ❑ Poor
❑ Lake,wetland,or stream ❑ High ❑ Inadequate
❑ Drainage ❑ System is causing visible
surface discharge.
COMMENTS:
�;U�G�tS'� , Q,��' �.�" 1,�����'- 'i-�—sU
Date of I�spection ' Septic System Inspector
Note: In the event that this inspection report is used to satisfy the requirements for a mortgage or other transfer of property,be advised that
this report does not guarantee or certify that an existing system will continue to function properly,but is merely an opinion of the adequacy
of the system under current conditions based on the available information.
This report must be kept on the premises with system location and pumping records.
WHITE COPY/Inspector's File GOLD COPY/Homeowner
GENERAL PERMIT CITYPERMITNO. �99� �
CITY OF ORONO Date .�- /� i- ���'
P.O.BOX 66
CRYSTAL BAY, MINNESOTA 55323
(612) 473-7357
�`��i� � �L �� �` %�r C> � c�X �--._
Owner /"l/�t�- Address �?`
Contractor <�� '�"��� �1/ "� Address ' � f� �1 �t)�' � - i��
,--�
City License No. /' �`� State License No.
REMARKS AND SPECIAL CONDITIONS
PERMIT TYPE AND FEE: '�J NEW ❑ ADDITION ❑ REPAIR
Inside Plumbing (#fixtures_) Fee $ Water Well Fee $ "���� '�
Water Meter (Size_) Fee � Mechanical Equipment Fee $
Meter#
Remote# Moving /Lifting Buildings Fee $
Municipal Water Connection Fee $
Land Alteration (Excavation, Fee $
� Grading, Filling, etc.)
❑Copper
Municipal Sewer Connection Fee $ Fire Fee $
❑ PVC ❑Cast n Sprinkler System (Fire) Fee $
MWCC SAC Charge Fee $ Other: Fee $
On Site Septic System Fee $ After-the-fact Investigation Fee $
ACKNOWLEDGEMENT TOTAL
The undersigned hereby acknowledges receipt of this limited
permit, including acceptance of all special information, . ��
terms, conditions or requirements written above. The Q
undersigned understands and a�ees under penalty of law State Surcharge: Fee ,p
that this permit is strictly limited in scope to the work,
activity or improvement specified; that this permit does �C'' ���
not grant any authority to do work or activities requiring Total Amount Paid to City F28 $��1
sepazate permit approvals; and that this permit does not
�ant authority to violate any provision of any City
ordinance or State law,rule or regulation. All work shall be
done in strict compliance with all City ordinances, building
�oaes and/or ne�tn department regulations, �a sheu be This permit is not valid until the proper fee is paid and
subject to inspection, approval or reiection by cne c;ty. it is approved by an authorized City Official.
Whenever so ordered, the undersigned agrees to correct
any work found to be in violation of the conditions of
this permit.
Signatur�p f,Appl'cant Signature of City Official
��4,,�'�� ,�-� 1_/�'�' � `- , ,.- �� � C�c�- _ _� ���
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Code:White—File Copy Canazy—Inspector's Copy Pink—Finance� y Gold—Applicant's Receipt
PERMIT
CITY OF ORONO PERMIT TYPE:
1335 Brown Rd. South • P.O. Box 66 ' �l�I i_�'t I���
Permit Number: ;yr}��`�5._
Crystal Bay, Minnesota 55323 Date Issued: i s�.lt��./��t r
(612) 473-7357
SITE ADDRESS:
�'�i=�ii F�!7( `�T
TLN
� . 1 .��. � i3,t�-�. j.�-y:�-_;�.-[lt)t�)'�1
DESCRIPTION:
nE�4f=E r n I�'�I�:I F'�'EL �+E'=� .
E=ui I"i���a �'�t�ri,i t- Ty��� I��;�i i/F'�;INt:I�'Ai_
E�ui l��i�►� Wc�i�4:: T���t� C�E1�;=�–��;s�d�_:IF'r�L r,��� .•;,� ,�r��r.�,;r�
L1! t L�! 1J/1UlSL
.............. i:��
� !i!Yf']ftlfL Vt t 1LL
S�:1J1 t�l'VVV T�!
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7'.�:�':'r'i ei tf}t�f� �
1i.i.4iV V VL V
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..:Fii•t, L�l. �7+.-1� L.r} t�IS
L!IL !1 tL .J17wJV
i �:�'i.';.'.... f:1:�t' t'��!
�C�ij�t_i� r , t:rm��� i t,�u
,k•; • : . i�ritii t:ri5 �j}-■,r�
rrivi%✓v"v t�vvi nVlli r'fkit�`G%'t
Vt�:l 1 f !lf
REMARKS:
GEi����L i T T+�iV T►�� EaE C�'f N�AV`� E����.�i F`tt�t�i; – E,t 1Fiiri I��!� �,�����i� �°�3 i�i i�.:T�; +=iNL'�' '==t Jf�.TE�:T Tf�1
i-�:s��`=: � ='=:i"��; :� �l ���,��ifi�Ihf►r.i F'�Fit�I-�
FEE SUMMARY:
�'t�i=t�._�j�!�i�_��� ��. ,i3i_lt3
E�aS� ��:� ���� .�:l�:i
`•�iL3}'C���E'3C ---�.Lai 3
j i�{.ct i �CC �u----- �Ci(3, �;C3
CONTRACTOR: -- ����.� i��E+�. -- OWNER:
R �� n c:hti:iyvr`-ii 1{'�� i�JC� Ii:�C�i�.y=� 4�IL.��t�ltHP�i P•IIi'�i��c
�-�1€_, T►�NF:::AWi i���U f:D 7�.� '=��:i t�f�a �-i I LL �;G
l�ii�h��it�3�4t:r"-� i�id ��c��� W'ri4":T'i��4"i-� �P� �+�::`�:i
t:�.i:`:t °�+_;�–:;'���. 47�–E�=�'1��
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�. ��=l='�t:I�i�� �;�t�7 r�i:�;���'�� T�� t'.�i�i �i�� �,���}±;��:: I i�i '��T?;i�.::; �:;i�°i#-�'L I Ai��:::�� �,�I T4�i r�f__� C:i TY i:;_
,r: rs� �.- n -----t-r• -r- r.� •t.} r•� t r h " ('1 ' t 7" !"'h:4 "
E_if�;l=ii`Jt' _ [.�I�`.ly-�,�f::�._; �FV�i '_: ���� �tr �i I�`titvE�W���=T� �.t,I L�..�I�+��� L:i��Lf� r4��txi��E ic���E�'v i�'��.
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- - �f ,� - -- - -
APPLICA 'f��^ITEE 'GNATURE ISSUEDBY SIGNATURF
,��`� S�
CITY OF ORONO APPLICATION FOR DEMOLITION PERIKIT
P.O. Box 66 (1335 So Brown Rd)
Crystal Bay, MN 55323
SPECIAL CONDITIONS & HOLD HARMLESS AGREEMENT
**�******��*�**���****:*�*#*�**#�*�**:*****�***�****#*#*t#***��****�*tt#*#
General Instructions
l. You may be required to obtain other permits, i.e. burning, we I 1
abandonmment, etc.
2. Work must not begin unless the permit card is available on the job
site.
3 . All work must be inspected before it is covered. Call 473-7357.
- 24 HODR NOTICE IS REQQIRED -
��***�********�***************#���**** **�*****�****tt***�*********�***�*
JOB SITE ADDRESS: , ^ � ,�'�� � ��` / �� "�,� �;: 0-�- �
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Occupancy Type: ��_Residential Commercial
OWNER'S NAME: � �, � Phone: �" ��� ����
Mailing Address: �� -' , City: �( ��,ti�,� ��
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CONTRACTOR'S NAME: � ' C' , us. No. : ��'
Mailing Address: y • � City:
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Demolition if planned by means of: manual disassembly �heavy equi�ment
�burnin `,'-- �''_=- '_`_ -`--•---t)
9 -1 -r-- -
Permits Issued:
# Burning Fire Department
# Well Abandonment
In return for issuance of said Demolition Permit, the undersigned owner
hereby agrees as follows :
1. The structu�e(s) shall be ke�t enclosed and secured until such time as
demolition is complete.
2. Demoli�ion debris will be ke�t off adjoining property and/or the
public rights-of-way unless specific prior a�proval is obtained in
writing for temporary use thereof.
�N oT(3uRN E�
3. All demolition debris1will be completely disposed of off site in an
approved landfill and in accordance with all applicable PCti
requirements (includin foundation).
4. Upon completion, and within 5 working days of superstructure removal,
the site shall be left clean and clear of all debris, with any
excavation filled with earth, level with the adjacent ground
�levation, except when such excavation is to be used as part of a new
building and such new building is actually under construction.
5. The undersigned owner shall and hereby does indemnify and hold
harmless the City of Orono, the City Council , and the agents and
employees of the City from and against all claims, damages, losses or
exFenses, including attorney fees, which the City, City Council and
agents and employees of the City may suffer or for which it amy be
held liable arising out of or resulting from the assertion against
them of any claims, debts or obligations in consequence of the
demolition described herein as performed by the property owner, his
employees, agents or subcontractors, whether or not caused in part by
a part indemnified hereunder.
************��*��***�*�*�********�**��*****�*******�**�**:*t**t*******t�***
PERIKIT TYPE AND FEE CAI,CIILATION
$50 .00 Principal Structure
$30.00 Accessory Structure
1. Subtotal of. above �ermit requested $
2. State Surcharge $ .50
3 . TOTAL PERMIT FEE (add lines 1-2 above) $ �� " �'�
**�****#t**t�***�***�*�*��******�r*##*****��*�t***:*�*:***#*t*#t**�*�*******
the undersigned hereby applies to the City of Orono for issuance of a
Demolition Permit, agrees to do all work in strict accordance with the
ordinances of the City and the regulations of the State of Minnesota, and
certifies that all statements made on this application are complete, true
and correct.
;
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SIGNATIIRE OF APPLICANT: � /G Date: � �> �
�aLe Issuea • oili7u rermiz Lo ne malyea:
Permit No. : �- - - or picked up:
CITY OF ORONO
P.O. Box 66, Crystal Bay, -MN 55323 _ -
30 Minute notice shall be given to the police department prior to burning-
544-9511.
Expires after 30 days from date issued. .. ��
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O P S N B U R N I N G P E R M I T
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SITE ADDRESS:��G, Sc�SSt'����.- T DATE ����,��n
�g c�Z� �'o�c .St -
Name: �NC � e: �-.�d i�t' (h) �C�����7`�7J (o)
Mai3.i g Address: �// City: Zip:^5���
Agent (if applicable) :
FOR THE PURPOSE OF BURNING c i�(� �
�i ►v �c�t�� ��h� `P���ev�� {z��rC'o�vs�r�c:��� asr��•
This application for open burnincf will be accomplished in accordance with
the conditions listed. The recipient of the permit sha3l comply with a1Z
other state and local Iaws regarding open burning inc].uding obtaining the
required permits. (NOTE : More than 5 times per year ( for all
organizations and individuals regardless of tax status) will be charged a
$100.00 annual fee. )
� �
Signature
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Approved by: Inspected by:
� " -c'( Q
Date: S -3 r
Inspectors Comments:��� O�l.� + <U/3SE��T � �G�s G/ST�d eN I'�
Fire Department: Long Lake Maple Plain Mound Wayzata
The Fire Department must sign this burning permit if they wiZl be doing the
burning f or the applicant.
Fire Department
THS FOLLOflING ITSI�iS are to be completed before the inspector arrives (If insp ector has to
re-inspect site becanse items vere not cosplete, there �+ill be a $20.00 charqe per re-
inspection):
1. Street address must be posted and visible from the street. Where more than one house
is served by the same private driveway or unnamed private road, additional sets of
numbers shall be placed at every fork or other driveway as necessary to disec�
traffic to every house including the house farthest from the street.
2. Burn pile must be stacked at burn site meeting the following:
- Minimum�50' from buildings
- Wood and paper products only �
- 8' maximum diameter, 4 high maximum - - '
3. Draw a map on back side of permit application locating the burn pile. � � �
4. Zf these conditions are not met, the permit will be denied and �you may not apply �o�-' , �
another permit for 30 days. - " � '
5. Read al 1 conditions on backside of permit before burning. Violations of �hes� �
conditions may result in the issuance of citations and permiC may be revoked. �
ALL SIT'$S WILL BS INSP$CTED before issuance of bnrning permit, 'subject to � �
availability of staff time. _
.__
- ; :: :; - ' - �
This permit is Iimited to the following conditions:
1. Fire must be attended at aIl times.
2. Provide water supply to burning site.
3. The prevailing wind at the time of the burning shall be away from
nearby residences.
4. The burning shall be conducted as far away from any highway or public
road and controll.ed so that a traffic hazard is not created.
6. The 3ocation of the burning shall be conducted not less than 50 feet
from any structure and adequate provision is made to prevent fire from
spreading to within 50 feet of any structure. If the fire is contained in
an approved waste burner it may be located safely not Iess than 15 feet
from any structure and fire extinguishing equipment readily avail.able for
use.
7. If burning of a superstructure occurs within 600 feet from an occupied
residence other than those located on the property, applicant must receive
permission from alI residents within 600 feet.
8. Oils, rubber and other smoke producing materials shall not be burned or
used as starting materials.
9. Any fire allowed by this permit shall be extinguished within four ( 4 )
hours of a public announcement by the Minnesota Po3lution Control. Agency
that an air po3.I.ution alert, warning or emergency exists. Such burning
sha13. cease until a similar public announcement terminating the alert,
warning or emergency is issued.
10. This permit is subject to revocation at the discretion of the Iocal
poZice department or the permit issuer if:
a) a reasonable, practicaZ aZternate method of disposal of the
material exists ;
b) a fire hazard exists or devel.ops during the course of the burning;
and
c) any of the conditions of the permit are violated during the course
of the burning.
11. Other reasonable conditions the permit issuing authority may impose.
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