HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
447-4230
Address:
APPLICATION FOR
EXCAVATING/FILLING PERMIT
Date
Contractor:
Address:
Consultant Engineer/Surveyor
Address:
Phone #
Location of Prol~rty:
Legal Description:
Will the excavation or filling be in a: Watercourse Wetland
Purpose for the proposed excavating or filling: 'r Q ~ so ~,e_ g_ s/..a,a~
Upland
Estimated start date: /a- x~.-at./ Comlfletion date: //-
What is the type of material to be removed or de..de.j~o_=,qle~k t: t_. ~,,q,,./ ~:/~.L
lnwhatmannerwfllthematerialbeFemovedand/or~? t~ Y o ~na ~T ~ ~a~ ~ gan c// ~'
What highway, street, or otber public way will material for r~moval or depoaitation be hauled or carried? ¥t~$
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obsta'uct~? ~
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE ~ll
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH TIlE OV~LM..L 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 plan7 Yes No V- If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (B) Comple~i legal description (C3 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 ali slopes to be shown on a 2' contour map at a scale of 1" :50' or larger: The proposed and original contours shall be shown in-
cluding all property within 150' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the S~at~ of k:;anesota .(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. let~r 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.
Amount of bond Letter of credit, or deposit of money liability, insurance provided
Permit fee Signature ofai~lican~ D~te /~- ,~-/'~,ff'
Permit deposit City Engineer Date
Permit is valid if signed by City Engineer.