HomeMy WebLinkAboutExcavating & Filling Permit
CITY OF PRIOR LAKE
APPLICATION FOR
EXCA V ATING/FILLING PERMIT
Permit No.
()/-G10
Date 8 I ~ I {} /
447-4230
Applicant ~I~~~ LL
Address: ~ ~ I . ~ :')(}-r W.
Phone # ~9- 3 22.,. 7Y<11
~~~'VtAf M;':;' Y11~ _ tj ~ 06"i)
Address:
Property Owner:
Address:
Contractor:
Consultant Engineer/Surveyor
Address:
Location of Property: J 5"'2. =g,
Phone
#
rn.r-b~J6 ~
PA do/' tk
M.A.
,~'"3/7.
Legal Description:
Will the excavation or filling be in a: Watercourse
Purpose for the proposed excavating or filling: .5'fa b;t-?e.
Wetland Upland X
/ahe~ and k~d.J I~:fi:trnj)-~ It/b~-
-=Uz~\O\
Completion date: ~\ 6 1
t=:e/c1 5:11nJe. (4 1# ~ -/l'Uck /~)
Estimated start date:
What is the type of material to be removed or deposited:
OUm(' 1ruc.iA.~ Mol I:::tu:.kk~"U:41h.br
In what manner will the material be removed and/or deposited?
What highway, street, or other public way will material for removal or depositation be hauled or carried? /i;'r f..ol1h!> r~ -/
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? YO/le
IT SHALL BE THE RESPONSIBILITY 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 TION AND/OR FILUNG 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 _ 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 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 througboutlhe
area and the proposed angle of all slopes to be shown on a 2' comour map at a scale of I" = 50' or larger: The proposed and origirial 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 Mj4neSOCa .(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 COslS 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.
Amountornd
Permit fee 7 ~ ~
Letter of credit,
liability insurance provided
Date~
Date8-Z-0J
Permit deposit
Permit is valid if signed by