HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
0 t/_,~_ ~ ~' Date ~ /
4474230
Applicant
Address:
Phone #.
Consultant Engineer/Surveyor
Address:
Phone #
Location of Propeny:
Legal Description: ~)~ ~
Will the excavation or filling be in a: Watercourse Wetland
Purpose for the proposed excavating or filling:
Upland
Estimated start date: ~" 17 -- O q
What is the type of material to be removed or deposited:
Completion date: 9- C"-
In what manner will the material be removed and/or deposited? y C~i,-<ff 7/0 6 e ~)
~at highway, strut, or o~er public way wi~ ~tefi~ for ~mov~ or de~si~tion ~ haul~ or c~ied?
~t, if ~y, s~t, avenue, i~e, ~iey, highway, right of way, ~o~ughfa~ or public gmuM will
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES 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 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 thmuIhOut ~e
atca and the proposed angle of all 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 en$ineet or surveyor registered in the State of M;anesota .(E)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or bamcade (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.
Amount of bond
Permit fee
Permit deposit
Letter of credit,
Signature of applicant
City Engineer
of money liability.insurance provided
Date
Permit is valid if signed by City Engineer.