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APPLICATION: DRIVEWAY CONSTRUCTION
TO THE CITY OF PRIOR LAKE, MN
PERMIT
NUMBER 03 - 001
DATE
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The undersigned herewith makes application for a Concrete or Bituminous
Construction Permit
(for office use only)
TYPE OF PROPERTY: ~ Residential 0 Commercial 0 Industrial
ADDRESS OR LOCATION i ~ I '5 S- ,q spr;. 'f{ II ve. f\L f. 'P,Q " u (L L fI It::' e , WI 'f\J S'C;' '3 72.
LEGAL DESCRIPTION OF ABUTTING PROPERTY J.. 0 i d. ~ I <.J C k 1 :/ /91\( d .p <: i'" Ii d '!;J. /1.. tlJ,/;,T<
BLOCK c1 ADDITION 1),t{f(dP{);V\.tr: ;)..J-Add.t,... OWNER 1,1/l(l~/d 13ol"toqofs/r::./
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DRIVE APPROACH
TO CONSTRUCT New [J
ff' '/. <;)- 0 (
Replace Jl1 Widen"
I wide (TEMPORARY ~MANEtillPrive app.
APPROVED BY:
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FEE COl ECTED
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Type of Material B.' tVIf'I l 'r4 ilV~
Qate
By
When widening or constructing new driveway approaches a $10.00 fee is required at time of application and a sketch of property
showing present and proposed driveways in relation to property line.
, (Sketch on reverse side of application or provide a separate plan)
As provided 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 further
agreed that no W.9rk In connection with this application will be started until the application Is approved and the permit issued.
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Contractor \
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APPlicantr~e
Date
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20 D3
REQUIREMENTS
1. No work under this application is to be started until application is approved and the permit is issued.
2. Where work on travelled 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 shallbefleft or deposited onthe road during the construction of driveway.
4. Road must be swept clean after work is completed.
5. Prior to placment of concrete or bituminous surtadng, the applicant shailnotifythe 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
inspector.
IMPORTANT: Before starting work. . .
The Applicant shall call the Gopher State Number (1-800-252-1166) 48 hours prior to starting work.
Applicant must call Engineering Depaltment (952) 447-9830) for inspection 24 hours prior to time of inspection.
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