HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
APPLICATION FOR
EXCAV ATING/FILLING PERMIT
Permit No.
G-/O
Date
7 I /0 I Ol)
447-4230
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Address: ~ 1-D b ~ ~:Ira L ~w \J ~ \tl)(tt~ \R \\ '1 t..
Property Owner: 'S1 tvE~ E.... "t."I N D\:'"-(l ':>
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Applicant
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Address:
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Contractor:
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Address:
Consultant Engineer/Surveyor
Address:
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Location of Property:
Legal Description:
Will the excavation or filling be in a: Watercourse
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Wetland Upland
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Purpose for the proposed excavating or filling:
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Estimated start date:
Completion date:
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What is the type of material to be removed or deposited':
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In what manner will the material be removed and/or deposited? ~ () \S. C ~T , ~ \t-o veL
What highway, street, or other public way will material for removal or depositation be hauled or carried? tJ l)\-J t.
What, if any, street, avenue,lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? ~O\J~
IT $HALL BE THE RESPONsmILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFAcnON OF THE crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A TION AND/OR FIWNO COMPUES WITH THE OVERALL crrY
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 ~ No --::i-.If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
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(A) Completed application form (B) Completed legal description (C) Map or plat of theproposcd filling or excavating showing location and amount of matcrial
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 throuIbout 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 ISO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of MiiUlUota ~
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. Ieder or
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 iMunace.
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Arnountofbond
Permit fee # 99, 2 5"'
Letter of credit,
or deposit 0 mo~ey
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Signature of applicant . "" '\.V"r.. .
City Erigineer ~ f 0 IJ (: I /)_0~v', rVV H
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Permit is valid if signed by City Engineer.
liability insurance provided
Permit deposit
Date
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