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DRIVEWAY PERMIT APPLICATION
PERMIT# Os-~ D II
DATE: /6//('60-
I
APPLICANT NAME:
(FOR OFFICE USE ONLY)
TYPE OF PROPERTY: Jxr Residential 0 Commercial 0 Industrial
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PROPERTY ADDRESS:
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OWNER NAME:
DRIVE APPROACH
TO CONSTRUCT: 0 New PrReplace 0 Widen
I ') roc -r wide (TEMPORAR~ANE~ive approach
AP/Vill:
Date: ,-
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Fee:
(Please provide ske~h on reverse side or on a separate sheet)
Type of Material P/,\IJI,Jjj: s.-n>I'J~ ( (c~a.~'jC,..J
-1110. () 0
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 permission from the Engineering
Department or inspector.
IMPORTANT: Before startinQ 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 Department. It is rther agreed that no work
in connection with this application will be started until the application is ap and the permit issued.
Contractor
Applicant's Signature
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Date:
I