HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
APPLICATION FOR
EXCA V ATING/FILLING PERMIT
Permit No. qg-YQ Date ID I q I qS
447-4230
Applicant &J uJ~'Iftrl-,'t11 C Ga.R.i- f.o 6..,1- JI..,J/IIlu'~) Phone, 70/7- ~ S'lrD
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Address: /, ?6 0 /6:t/'l1W"ir) cuJC.
Property Owner: W fi..,-+-I--e;y-Lt'.if ;;:: we.... Phone # S~ /1'1-1 Q'
Address: t::> ~.Vl"'\. e'
Address:
6d1l me
S~d
Phone # ..54\ n., ~
Contractor:
Consultant Engineer/Surveyor /3N t ~ Q(.$IJaJks hone # t/l/~ - i"~:r<6
Address: (t} 0 ~ a -- I/O') f/Q z.eJ~~ (61 U 011 C/k4 ~ /:=, 0
Location of Property: [r) 0.. P I ~ vJ a 0 J S"f-tre e +
Legal Description:
Will the excavation or filling be in a: Watercourse
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What is the type of material to be removed or deposited:
Estimated start date:
ill ~ri~ bercmov~or::1? ~~d'J ~ ~ {&,.J. M<.
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What highway, street, or other public way will material for removal or depositation be hauled or carried?
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed?
IT SHALL BE THE RESPONsmILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE sAnsFAcnoN OF THE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V AnON AND/OR FIWNG COMPUES WITH THE OVERALL CITY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN, SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORT.
ING CALCULA nONS OF A REGISTERED PROFESSIONAL ENGINEER,
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes _ No X- If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (8) Completed legal description (C) Map or plat of the proposed filling or excavating showing location and amount of material
proposed 10 be removed of deposited. with a description of the area (D) The depth or heights to which such removal or deposition is proposed throughout the
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of I" =50' or larger: The proposed and origiria1 contours shall be shown in-
cluding all property within ISO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of MiBnelOCa .(E)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade (H) Application fee (I) Bond. letter of
credit. or deposit of monies in a sum sufficient to pay the cost of restoring a sile. The extra ordinary costs of repairing, highways, streets or other public ways
along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything 7ired to be done (1) Public liability insurance.
Amount of bond. - Letter of credit, -. or posit 0 'f 10 8~'~~1iabili insurance ProVi~ed ~5
Permit fee $50 ~ Signature of applicant Date
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Permit deposit rDll 1~_City Engineer Date ;~/'l11fY
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Permit is valid if signed by City Engineer.
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