HomeMy WebLinkAboutExcavating & Filling Permit
I
CITY OF PRIOR LAKE
APPLICATION FOR
EXCA V ATING/FILLING PERMIT
Permit No,
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Date
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I
{"L I ~t./
447-4230
Applicant ~ ,'.5h ,d",.",r ;c~
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Property Owner: i1 ;/"'" /If~J~
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Contractor: f:~k e,....r Iov
.
Address:
Phone # $"q"t)-7'DfJ
PrtrJr k/~.. Af,J ~:~.J' 72.....
Phone #
Address:
/lI~D",d: A1J S511i:f
Phone # bIZ 815 ZJJ2.L
Address:
Consultant Engineer/Surveyor
Address:
Phone
#
Location of Property:
Legal DesCriPtion:~ ~
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;tie>
Wetland t! D
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Uplanci _~
Will the excavation or filling be in a: Watercourse
Purpose for the proposed excavating or filling: .:;;r;s-.I.1J (
Estimated start date: ~; 2.et:J 4
What is the type of material to be removed ~~
Completion date:
hil
AlfJV 30 I z,o,C{
In what manner will the material be removed and/or deposited? ---1a,. fl'LN;.t:-
What highway, street, or other public way will material for removal or depositation be hauled or carried? .l1,.,~s' S~.
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? ~
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SAnSFACI10N OF THE crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V AnON AND/OR FlLUNG 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 ~ If
yes, show p.vt'v~ 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
r- 'r ,.led to be . __'w led of deposited, with a description of the area (D) The depth or heights to which such..". aJ or deposition is r 't'..eel throusl\OUt!he
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of I" =50' or larger: The r "r ..ed and origiriaJ contoun shall be shown in-
cluding all r' -r...J within ISO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of Mi", ~... ,(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 (J) Public liability insurance.
Permit deposit
, ,)-etter of credit. or ~oney A liability insurance provided
Signature of applicant ~ ~ Datet;.AJet/f7l/
City Engineer ~ Date JJ) J t./ 0 y
permi~~ signed by City Engineer.
Amount of bond
Pennit fee 60. ~ 0