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DRIVEWAY PERMIT APPLICATION
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'I'l~~ OCT 142005 Illl
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PERMIT #
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DATE:
TYPE OF PROPERTY:
APPLICANT NAME: ' h cd .J.. S pI? ( .'c, /-+. ~ S"
OWNER NAME: DQ.llas. Gr.e.. t::.O-/t
PROPERTY ADDRESS: I (p ,n!'.., ~ J (, % 9 J f:./t'V) A v.~ S' .{,U.
wide (TEMPORARY ~~MANEN~) Drive approach
APp~ir
Dale:
10 O-e S-
DRIVE APPROACH
TO CONSTRUCT: 0 New ~RePlace
-1 q l<.d-
t
A-SPha. I t
o Widen
Type of Material
(Please provide sketch on reverse side or on a separate sheet)
Fee:
11tJ. (JiJ
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 Del>. ,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. ASP~vd"" :s p~<'I'r; H,Li: $ .
Contractor
Date:
A.G. T.- ASPHALT SPECIALTIES COMPANY.
"+5 ~ LJa (q'.5
LV ADDRESS I to <i
Gal HOUSE !;at rrit)( La Ke
~ HOME PHONE
.- fS:) '-/10 - 90/;0
~ LEAD SOURCE DATE SOlD
I ///4, ">E sF' ~f1
~:.. LEAD'
~ APPOINTMENT ESTIMATOR
WOOKS/-EET
i..o YES
TREE STLtvlPS tzf--. 0
TREE ROOTS ~ 0
SPRN<LI~ SYSTEM Ji 0
PH:J.E: WRES lIt 0
ELECTRIC WIRES ~ 0
=S~CH ~ ~
DRANAG: PROOlEMS 0 .? 0
,
ffiADE C/-Wo.IGE 0 0
/-EAVI~ b-- 0
CNERI-EAD UNES r)... 0
TREE L1~ l1L 0
Roa= Ov'ER1-1AM3 'rt{ 0
CHAIN SAW )l 0
BlOCK REPAIR )( 0
WORK PHONE
PROPERTY LINE DISTANCE
EXC1VATE $
E,@
JACK
HAMMERC
EXTRA
TRLCKS OUT
SAW CUT
EXTRA IRK
LCY\DS IN
MIRAFI
10'
REPLACE
WITH
@
SIDEWALK _
JlI"$~~XP -
II /3 :J-a..~ _
SEALCOAT -
CON
SEALS -
~
7, ~ 50
CROSS STREET
CALL GOPHER
ORQE
g:{v :;:"3]).
TIME
1'..0 YES
~:/q:4K;~~
02J
o!(
REPLACE AS IS
: r~dt:/1 :-t
FlARES
I
/.,
$
GRASS GRAVEL
OTHER
K
% .p.{~
f<-
Alc
SCHEDULER: PG SIP 0
~?L.
, J.';l..-
o OK TO USE BOBCAT IN
YARD. CUSTOMER IS RESPON-
SIBLE FOR ANY YARD DAMAGE
{\ND RESTORATION.
CUST. SIG.
REGARDING THIS INSTALlATION,
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. ... .
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CUST.SIG. ~
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COMMITTED TO EXCELLENCE
6101
PG 2 OF 2