HomeMy WebLinkAboutExcavating & Filling Permit
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CITY OF PRIOR LAKE
Permit No,
APPLICATION FOR
EXCAVATING/FILLING PERMIT
DL/ -h -Oil Date S- I ;?b OL[
447-4230
Applicant AJ e A / () J.s 0 A.J
/~.30 ~/:>'{ ./1 T Ifd
r .~t'''rty Owner: Ale. A- / (!J ISo/tl
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Address:
. Phone ,S;f 111 e..
Address:
Contractor:
[)cr-::J i MdsL~jJ/n1
/ I
9$..< - "AS'8" -'1.< oS--$-
. Phone' .
Address:
Consultant Engineer/Surveyor
Address:
Location of Property:
Legal Description:
Will the excavation or filling be in a: Watercourse Wetland Upland X
Purpose for the proposed excavating or filling: 111 If. Ls C.I1Jt1e- H"''\. 'f- V"f1tI'd' /,', ') / fD /(t') I
Wt'!~r!J c:J- j(eeJ ('11\.I'-i--I'r,AO~ W,fS~I'l.tr /~fo .s'fi/'~f:-i
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Phone
,
Estimated start date:
Jv{I1~
6'1
Completion date:
L ,'1'118- $'~rlc:.-
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What is the type of material to be removed or deposited:
In what manner will the material be removed and/or deposited?
~ f/ h If" J l1- &>6 c.,ff-
What highway, street, or other public way will material for removal or depositation be hauled or carried? E:5/; h: II I.
What, if any, street, avenue, lane'Jlley, highway, right of way , thoroughfare or public ground will be obstructed?
~~~Mh# .
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFACTION OF THE Crry
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A TION AND/OR FILUNG COMPUES WITH THE OVERAU. 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 p. vt'vsed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes
yes, show proposed effect.
No
If
SUBMISSION REQUIREMENTS:
(A) Completed application fonn (8) Completed legal description (C) Map or plat of the proposed tilling or excavating showing location and amount of material
r' "r "sed to be removed of deposited, with a description of the area (D) The depth or heights to which such removal or ~'r" .irion is r' . r . ~ throughout the
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of I" = SO' or larger: The r . r . ~ and origirial contours shall be shown in.
cluding all pr -r -..j within ISO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of M;l1IIeIOta (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 sufticienllo pay the cost of restoring a site. The extra ordinary costs 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 10 be done (1) Public liability insurance.
Amount of bond
Permit fee ~3,Sn
Permit deposit ~J1)
Letter of credit,
~ignature of applicant
City Engineer
or ~it Ofl'?nf~" liability insurance provided
7..te..4 U Date s/4FAtJ.-
1<;l/1 <- I 5
, /~ . A. Date %4 ~t!
Permit is valid if signed by City Engineer.