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CITY OF PRIOR LAKE
DEMOLITION PERMIT
Date Rec' d
5- /7. tJ~
(Please type or print and sign at bottom)
I ADDRESS
52-gO /(0 SI~~
I PER..1VIIT NO. ()S-. 0450 I
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID zS: 9.3(P. (J(p3.01
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(Address) P (' i P (" iA Ke-
(Phone)
CONTRACTOR
(Company Name)
(Contact Name)
(Address)
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(Phone) 9 $' c:;~ L/ 6/- .3 ::< G S-
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Use of Building: A ;L II>TT"E:ll.1\.v.nol'1AL BUIL1Jmv LUJ...1E" /
oS . .tIt-.. . Type of Construction: I IT ill IV V A B
l).Jbl...t:, ('-'1 ~"'" Occupancy Group: A B E F HIM R S U
I Division: 1 2 3 4 5
~CA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that
I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I hereby agree that the city official or a designee may enter upon the property to perform needed inspections.
r-i,?- Cf -- 4 - tJ.5-
Date
This is to certify that the request in the above application and accompanying documents IS in accordance with the City Zoning Ordinance and may proceed as requested.
IV\.. -
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~ Date
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I
Planning Director
Special Conditions, if any
24 hour notice for all inspections (952) 447-9850. fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
tflUtJ:) tl/t~ 5/9. oS-
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Site Restoration Proposal for Demolition
Applicant: j,c:I~tblS:-ch,{J /7)J'7r,Gf 7/9
/
Address: S3Co uJ~fJ1/oocl2h~.
Check boxes below: roY'" 52 i D /~D tit .s 7:' s,'f.c;
~ill Excavation to grade
~ Sod or seed all bare soils
of Erosion control (see handout). Maintain erosion Control until turf is established.
.,/ Cap sewer below grade. * Mark location. Licensed contractor required.
.r Cap water below grade. * Mark location. Licensed contractor required
"/Call City of Prior Lake Public Works Depal1ment for water meter removal.
~...cap gas line. * (By gas company)
,,(' Disconnect electric at meter. (By electric company)
o Pump and fill cesspool/septic tank. Certified contractor required.
.,...... Abandon well. Cel1ified contractor required. Existing welJ
""----Remove existing structure foundation and footings, materials, and debris. * *
vProvide dust control by following means:
]. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide surveyor draw site plan)
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*Capping of uUities must be inspected.
* * Final inspection and approval of restored site required. Deposit wilJ be returned after
approve final inspection.
Signature
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J:.BGILDING\HANDOGTS\Demo Site Restor.doc