HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
CI C( (7 - oS'"
Date
I
I
447-4230
Applicant f1,' t. ~ I~ I <:; . VCfV"\ ,1 r-,(
Address: I i) if(. R v.:/y-s .J~~ P {'.~ L....~ fYJ.
Property Owner: .f1.1fc l. 'f ('Fa l---lJ,,,,, Ar5'<
Address: , '-f) % f \A +y-- i j ~ cd- /J{... "-
Contractor: fJ,--.....1(
Phone # Cf'fS- 7 ?1-j
Phone # 'i7<;?7'i-J
Phone #
Address:
Consultant Engineer/Surveyor
Address:
Phone
#
Location of Property:
Legal Description:
Will the excavation or filling be in a: 1J:aercourse
Wetland
Upland
Purpose for the proposed excavating or filling:
..20', :~ ~. ,fJ-
"
Estimated start date: l Tt..."\<- ,oz. r~
What is the type of material to be removed ~
i/~c"
Completion date: 6~
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In what manner will the material, be removed and/or deposited? GJJ....c.cl k '-'-<./ .
What highway, street, or other public way will material for removal or depositation be hauled or carried? f..1.-t t;.{rf' S~J.-~
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? t<JN ,
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFACTION OF THE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A TlON AND/OR FlWNG COMPUES WITH THE OVERALL CITY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORT-
ING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes _ N~ If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application fonn (B) Completed legal description (C) Map or plat of the proposed filling or excavating showing location and amount of material
proposed to 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 " = SO' or larger: The proposed and origirial contours shall be shown in-
cluding all propeny within 150' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of MilllleSOta ,(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 site. 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 required to be done (1) Public liability insurance.
Signature of applicant
City Engineer
liability. insurance provided
Date~
Date ~-
,
Amount of bond
(J~ it - tt...
1J:; 6'1'1/ Permit fee) (). -
Permit deposit
Letter of credit,
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Y City Engineer.
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