HomeMy WebLinkAboutDriveway Permit
DRIVEWAY PERMIT APPLICATION
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\\~ OCT 1 4 2005
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DATE:
TYPE OF PROPERTY:
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PERMIT #
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APPLICANT NAME:
, ~. 'Spe('AI"",~~
'D~lIas. Gr-t-KO-tf
PROPERTY ADDRESS: I (p RiVi i- J '" -g q I
OWNER NAME:
~ II'\') A V~
s.w.
DRIVE APPROACH
TO CONSTRUCT: 0 New ~RePlace 0 Widen
19 l0
t
Type of Material ---'15 P h a. I t
wide (TEMPORARY ~~MANENT) Drive approach
App~:
Date:
10 17-cS-
(Please provide sketch on reverse side or on a separate sheet)
Fee:
i/o, GU
REQUIREMENTS
1. No work under this application is to be started until application is approved and the permit is issued.
2. Where work on traveled roadway is necessary, traffic must be protected and flags, signs, safety cones and proper
barricades must be placed in accordance with safety procedures.
3. No foreign material such as dirt, gravel, or bituminous material shall be left or deposited on the road during the
construction of driveway.
4. Road must be swept clean after work is completed.
5. Prior to placement of concrete or bituminous surfacing, the applicant shall notify the Engineering Department that the
work has been completed and is ready for final inspection.
6. No changes or alterations in entrances may be made at any time without written oermission from the Engineering
Department or inspector.
IMPORTANT: Before startina work...
The Applicant shall call Gopher State One Call (1-800-252-1166) 48 hours prior to starting work. Applicant must call the
Engineering Department (952) 447-9830 for inspection 24 hours prior to time of inspection.
When widening or constructing new driveway approaches a $10.00 fee is required at the time of application and a sketch of the
property depicting present and proposed driveways in relation to the property line.
(Sketch on reverse side of application or provide a separate plan)
As provide in Ordinance Numbers 1107.205 & 1107.206> I, We the undersigned, herewith make application
for permission to construct the driveway at the above location, said driveway to be constructed to conform
with the standards of the City of Prior lake and to any special provisions included in the permit. It is agreed
that all work will be done to the satisfaction of the Engineering Dell, . ment. It is further agreed that no work
in connection with this application will be started until the applicati is approved and the permit issued.
A . c..T. A sPJv:l f- :5 p ~ c. ,'r. J .k~ s '
Contractor
Date:
ArC. T.- ASPHALT SPECIALTIES COMPANY.
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t.U ADDRESS I &, ~
681 HOUSE !;at rriD( La Ke.
~ HOME PHONE
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~ LEAD SOURCE DATE SOlO
/ sF ~tl;}t
i /,../4.~ TIME ~ I
~_.. LEAD'
~ APPOINTMENT ESTIMATOR
WOOKSt-EET
i.JO YES
TREE STLtv1PS ~ 0
TREE ROOTS ~ 0
SPRN<LIM3 SYSTEM Ji( 0
PI-OI: WRES ):(. 0
ELECTRIC WIRES )i... 0
CABlE p( 0
WATER SI-UT OFF p( 0
DRANAGE PROOLEMS 0 .? 0
,
ffiADE Cf-W..IGE 0 0
I-EAVN3 1k 0
OJERH:AD Uf\ES r"l-- 0
TREE L1M3S 'j!(. 0
RlXF <NERHAM3 ~ 0
CHAIN SAW )i 0
BlOCK REPAIR y( 0
EXC1VA TE $
E,@
JACK
HAMMER@
EXTRA
TROO<S oUr
SAW CUT
EXTRA TRK
LCY\DS IN
MIRAFI
10'
REPLACE
WITH
@
SIDEWALK
rxp
J113
I( / 3 :J-CJ..~
SEALCOA T
CON
SEALS
~
'7J 4:> 5' ()
ORQE Ldr~ MAPCO-OO .
TIME C (051 !jX) 3])
~ YES
REPlACE AS IS 0 "k'
RARES 0 ~
PROPERTY LINE DISTANCE
CROSS STREET
CALL GOPHER
~: /1 :-1K(~
I
~
WORK PHONE
GRASS GRAVEL
OTHER
PG SIP 0
o OK TO USE BOBCAT I~
YARD. CUSTOMER IS RESPON-
SIBLE FOR ANY YARD DAMAGE
f\ND RESTORATION.
CUST. SIG.
REGARDING THIS I NSTAUA TION,
OR TERMS OF THIS PROPOSAL,
IS EVERYTHING YOU WANTED
IN WRITING? IF NOT, PLEASE
PUT IN WRITING AND ATTACH.
CUSTOMER TO PAY ANY
REQUIRED PERMIT FEES.
$200 ADDITIONAL FOR MAJOR
BLOCK REPAIR. ... . '.
.'. _: ,::,',0(' ~,~~'.:r
CUST. SIG. ~
1<-
% {'II~
R
A{C
6101
PG 2 OF 2
$
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COMMITTED TO EXCELLENCE