HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
APPLICATION FOR ;
EXCA V ATING/FILLING PERMIT
Permit No.
no)) - IJ 1
Date 5 lito I 00
447-4230
Applicant .tJ. J- S -:;:J:: ^ ~ ~ :1.-/- "''- <:. .., +.~ Phone' . 9'1 {J ..... 1 ~(J tJ
h ,:", -J~ ",-r Rd .s ~ P..~()...IA.K", )102
Property Owner: __'h ~ ( _ Phone' 6S'J-~o/~9
Address: 9 3 10 8 ~ 80 <::> -j- w ("" j S 1'- -e".. JP1I1 S- S"'a <(' y
Contractor: S +0 ('\ Il e l- 6 X' ~ 1'1.. V G\ -+ i: IA. ~ ~ Phone' ~ '9 c '... Y,,1. "II
Address: <f 'J- '17 W L ~T-/. S r S a...J o.~ "" I/YI /.I.. S S" 3 "7 'Y
Consultant Engineer/Surveyor _g reA \..\. Y\ T J\ +e V' ,~' Phone , 9Y;).-/7't'!J
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Address:
Location of Property:
Legal Description: L
;A pIs
.
AJI\
Address:
Will the excavation or filling be in a: Watercourse Wetland Upland
Purpose for the proposed excavating or tilling: '"TO f.-'"'--.c p {).... VI 'l!"" --I- h ~ S '~ 1- ~
~c.,.. (~"'- ~~ n-..&d;' tibt\ 7-0 ~L'" 'V fr-~s ~,,1-
~ lA-rl cl:~ ~
Estimated start date: ~- 9-~o Completion date: ~- /6- c) 0
What is the type of material to be removed or deposited: 8 J c:t. c:! j( d.; ~ + I C / u.... y c:Jv'a. ~ (}... )\. J
-;) fI I /
~)CbC) Y r<vS -ft\ E ~ O('JY.I ~ 9(9~ V rei ~ .-f-/j x ~Jt}()....r-
I / r
In what manner will the material be removed and/or deposited? B ~ ~ U 1+ <:) c: ..J +.., ~ C\ J1..:s
What highway, street, or other public way will material for removal or depositation be hauled or carried? c- +1 ~,
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? JJ {!} k.e..
IT SHALL. BE THE RESPONSIBILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SAnSFAC'nON OF THE crrv
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V AnON AND/OR FIWNO COMPUES WITH THE OVERALL crrv
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 stonn water management plan? Yes _ No -X- If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (B) Completed legal description (C) Map or plat of the proposed filling or excavating showing location and amount of marerial
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 throulhout 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 origiria1 contouR 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 Stare of MillllelOCa .(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: way.
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.
Amount of bond Letter of credit.
Permit fee 4f '3 S 8" ':>D Signature of applicant
Permit deposit lJ1). 0 0 c~'<Engineer
liability, insurance provided
Date 5"- S':O(:)
Date '5/1& 100
Permit is valid if signed by City Engineer.
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