HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
447-4230
Property Owneri
Address: ?,
Contractor:
Address: ~1
Consultant Engineer/Surveyor
Phone #
Phone
Phone #
Address:
Location of Property : H0~O ~'fO.i',,OGOOOq~[ 7'-~ ~ ~
Will ~e excavation or filling ~ in a: Watercour~
~se for ~e pro~s~ excavating or filling: ~
Wetland. Upland
Estimated stun date: dT-6tgle ? Completion date:
What is thc type of material to be removed or deposited: ~i~.¢,,Y-- c/i'/Jr-
In what manner will the material be removed and/or deposited? bO /'/OI
What highway, street, or other public way will material for removal or depositation be hauled or carried?
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 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 SUFI~RT-
lNG 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 malerial
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 1" =50' or larger: The proposed and origifial 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 State of Mitmesote .(~)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or bamcade 04) Application fee (X) 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 in cuff doing anything required to be done (J) Public liability insurance.
Amount of bond Letter of credit, or dep6sjt_~f-~oney _ liability,insurance provided
Permit fee ~ ~, ~'0 Signature of applicant //~ / / Date ff¢'~'t~)4
Permit deposit City Engineer ~ ~ ___ Date ~/~'/~) Y
Permit i~alid i~signed by City Engineer.