HomeMy WebLinkAboutExcavating & Filling Permit
CITY OF PRIOR LAKE
APPLICATION FOR
EXCAVATING/FILLING PERMIT
Permit No.
oS" -~ -05
Date
I I <t I oS-
447-4230
Applicant --;)~/ &~
Address: a:-III Pfpa./OX'A 7A./ J/ e-
Property Owner: DAVlt/.f-.. '1!:>-e:-Is7f ~d(
Address: /0 i I qp?a.llZlSrl '7k I /tk3.'
Contractor: [)o L~!cor :5 cl /u-i-or,
Address: /65"'/0 ~'rl(, Au~ S.. .-t5tc.VY"Vt/t'-ff!efl-,
Consultant Engineer/Surveyor
Address:
UII a: )
Phone# ~/2 ~-~
Phone# 9~2-4iVl-~"IP
Phone #
J?7/V 53-~3 I
Phone
#
Location of Property:
Legal Description:
Will the excavation or tilling be in a: Watercourse
Purpose for the proposed excavating or tilling:
" j 6V-;~/ ~
Wetland
/
~
Estimated start date:
7/7/0-:>
~ ,
Completion date:
~D;L
?//.~~~'--
What is the type of material to be removed or deposited:
In what manner will the material be removed and/or deposited? . 3-
What highway, street, or other public way will material for removal or depositation be hauled or carried? Co I2c I 2 I
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed?
-
IT SHALL BE THE RESPONSffiILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFACTION OF TIlE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A nON 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 XIf
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 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 origiriaJ 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 Mionesota (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.
Amount of bond Letter of credit, ~r cl~t of money
Permit fee J tdJ. Ii' ~...:>u Signature of applicant. .) ~~
City Engineer ~ /2...
Permit is valId If SIgned by CIty Engmeer.
liability insurance provided
..Q:/ Date 118/~--
. Date 7/ Ilos-
Permit deposit
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE nue
g-3/~ 3:00
ADDRESS -1 SIll /l,P" I ms~ T rl
OWNER ~VI'J B<..cA( CONTR.
PHONE NO. Ct). - n-v - tllfJ PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~AL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~LING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMMENTS:
Vv-e, I/{ ~ I(
\( WORK SATISFACTORY, PROCEED
.I' 0 ~RRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl