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APPLICATION: DRIVEWAY CONSTRUCTION
TO THE CI iY OF PRIOR LAKE, MN
PERMIT
NUMBER
-:It 05"- %- tJl
'Ilu /45"
t.
Th~ undersigned herewIth makes application for a Concrete or Bituminous
Construction Permit
DATE
(for olllce ",. only)
TYPE OF PROPERTY; )(Residential 0 Commercial 0 Industrial
ADDRESS OR LOCATION 58) I T/l!1btl' Tr I 5 E
LEGAL DESCRIPTION OF ABUTTING PROPERTY
BLOCK ADOmON OWNER
APPROVED BY'
DRIVE APPROACH
TO CONSTRUCT New 0
23
tmi3
ReplaceX WIden 0
, wide (TEMPORARY, PERMANENT) Dri'~e app.
FEE
Type of Materiel
0.1.
By
When widening or constructlng new drtveway approaches a $10.00 fee Is requIred at time of application and a sketch of property
showfng present and proposed driveways in relation to property line.
(Skefch on reverse side of application or prOl/lde a separate plan)
As provided In Ordinance Numbers 1107.205 & 1107206, I, We the undersigned, herewIth make application for permissIon to construct the
driveway allhe above location, &aid driveway \0 be constructed to conform with the standards 0' lhe City of Prior lake ~nd 10 any Special
orovlsion. Inchlded In !he permit. Ills agreed that all work wHl be done to the sellsfaclion of the Engineering Department. Ills further
sgrud that no work In connection with lhls appllcalion willlle stlrtltd unflllhe appllcaUon I. approved and the permlllssued.
A.C.T. . Asphalt Specialties
547 Wa&ttlsdaunty Road E
Shoreview, MN 55126 Date
.~~ ,--JJ~~L1-'
Applicant's Signature .
~
N- - lCO
2oa5-
REQUIREMENTS
1. No work lmder lhis application 13 to be slarted until appllcaUon is approved and the permit Is issued.
2. Wh9re work on travelled roadway Is necess!lry, Irafflc must be protected and flags, signs, safety cones and proper barricades must be
placed In accordance with safety procedures.
3. No foreign malerial such as dirt, grevel, or bituminous materia! shan be lef! or deposited on the road during the conslruclfon of drfveway.
4. Road must be swept clean aftar w(lrk is comp/eled
5. Prior 10 plecment of c;oncrete or bilumlnous surfacing, the appUcanl shall notify the engineering Deparment 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
Inspeclor.
[: IMPORTANT: BeforestartiJlgwork... .
The Applicant shall call1he Gopher State Number (1-800-252-1166) 48 hours prior to starting work..
Applicant must call Engineering Department (952) 447-9830) for inspection 24 hours pIlar to time of inspection.
;clU~I~97'f
J- :.-
A.C.T.- ASPHALT SPECIALTIES COMPANY
... NAME
E+ -.D
~ CITY
~
~
WORt\SHEET
TREE STL.t.1PS
TREE ROOTS
SPRINKLING SYSTEM
PHO\IE WIRES
ELECTRIC WIRES
CABLE
WATER SHUT OFF
DRAINAGE PRC8LEMS
GRADE CfW.JGE
HEAVING
OVERHEAD LINES
TREE LIMBS
Rcx.l' OVERHANG
CHAIN SAW
BLOCK REPAIR
NO YES
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
)2J EXCAVATE
&
BASE
I i 6.~ E/B D
b@
JACK
HAMMER@
EXTRA
TRUCKS OUT
SAW CUT
EXTRA TRK
LOADS IN
Bib" ~w.
10'
REPLACE
WITH
EXP
SIDEWALK _
@
~
NC
SEALCOA T -
CON
SEALS
HOUSE
G
F'ROPERTY LINE DISTANCE
("k
CROSS STREET
CALL GO;:HER
A/~
/0
:~~.
-----l '_
t-f 3 ~(; --L
38'
~
<If S
ESTIMATOR
lEAD #
ClRQE
MAP CO-OD
TIME
'f
bOO .,;. r
NO YES
REPLACE AS IS
60
o ~
, GAr<..,
FLARES
TYPE OF REMOVAL
1.-1. '
'r
GRAVEL
SCHEDULER: PG SIP 0
~A
.,/(
,~ '
.f
OK TO USE BOBCAT
OR TRUCK IN YARD.
aJSTOMERS IS RESPONSIBlE
FOR ANY YARD DAMAGE AND
RESTORATION.
CUST. SIG.
REGARDIN 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.
;>..g.
'~3 .
/'~
. . / $. t .
~y
COMMITTED TO EXCELLENCE
-'03
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PG 2 OF 2