Township Demolition Permit Application AULA PLICANT COMPLETE INFORMATION BELOWUMUUMMUUNUMMMMMUU Project Address: ao Zips Property Owner! ‘Applicant: (if different than the owner] Name: ‘Aatet Gity: Zip: Phone: Contractor: Name: —___ Address: City Phone: “Type of building being demolished: ‘Commercial _ Agricultural Primary use of the building: Residence Ottier ‘Type of disposal: Demolition and off site disposal is.required. What is the name and location of the land&ill; Burial or burning: If all or portions of the structure are proposed to be burned or buried on-site a permit is required from the MIN Pollution Control Agency, contact Mark Hugeback, 1-800-657-3864. Provide a copy of ‘the permit with this application, Septte Tanks:-Are there septic tanks on the site Yes__No __, if yes, will the tanks be abandoned Yes __ No __, ifyes, who is the licensed pimper pumping the tanks: Name: ‘Livense # Clsterns: Is there a iste? Yes__No __,[ifyes it must be removed or filled with sand or gravel]. WolteAro there wells on the site: Yes _No___.[ifyes how tiny ___1, Are the wells being abandoned Yes No__, [if yes who is the Licensed Well Contractor sealing the wells}: Namie __ Phone: License # ‘Tanks: Are there petroleum or hazardous material tanks on the site: Yes _ "No ___, {if yes who is the licensed contractor removing the tanks]: Name Phone? License # Asbestos: Is there asbestos present in the building: Yes __ No... If yes asbestos abafemont contractor: Name: Phoned ‘License Comments/Additional Information: Thereby cextify with my signature that all data on my application form and site plan are true and correct to the best of my knowledge: Applicant's Signature: Date: Phone ‘Name (please print}; Phone: * Provide a site plan of the property showing the location of the building that is being demolished. [OVER]TAAL UHL fice Use Only (MITTEE Planning: Reviewed Date: Subject to the following conditions: Building: Reviewed by: Date: Subject to the following conditions: Environmental Health: Reviewed by: Date:, Subject to the following conditions: ‘Waste Management (if needed): Reviewed by:__ Ifyou have any questions, please feel free to contact the Planning & Zoning Office ‘Monday through Friday, 8:00 am to 4:30 pm Jim Braun, Zoning Administrator Office of Planning & Zoning 2428-115" Avenue Princeton, Minnesota 55371-6200 Metro: 763-389-3487 Toll Free: 1-800-851-3383 Cellular; 612-282-9496 Fax: 763-389-9587SITE PLAN 1D Property Lines North Arow a Seale of Drawing: square =__. “Required information as por Section 505,16 of the Rice Cownty Zoning Ordinance — Can be submitted on separate sheet Check box when complete: 90 ooo ° Solls information ‘Lakes, streams and wetlands Bxisting land uses onsite and neighboring, ropertiss ‘Areas subject to flooding Existing and proposed structures, building foot- prints and setbacks ‘Traffic goneration a econ ‘Landscape plan including existing vegetation Rotds labeled, tooess to lot/dciveway Sowage treatment plans Stotm water and Brosion Control plans ‘Working and abandoned wells