HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
APPLICATION FOR
EXCAVATING/FILLING PERMIT
Permit No. [ ) ~ ,L~- 0 ] Date ,~'
447-4230
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Applicant L~g~'6~..,..Y ~.d /~o~/~ Phone#
Property Owner:
Address:
Contractor:
Address:
Consultant
Engineer/Surveyor
Phone #
Address:
Legal Description:
Will the excavation or filling be in a: Watercourse Wetland Upland
Purpose for the proposed excavating or filling: '7~A/~' ~'o,.n~' a,~ -~,6~J'/~.,.n~e a,-,7'-o~~' ~'~'
Estimamd start date: Completion date:
What is the type of material to be removed or deposited: ~,~,/905~'~"-- ffeq~'~ ~,~ R~C/~(~0 ~.//~$.t ~t~.
In what manner will the material be removed and/or deposited? ~"~ ~.r~,',e~ ~, "~X~. ~ ~' /~.~ t,"?.~-~'"-
What highway, street, or other public way will material for removal or depositation be hauled or carried? ~',,~'~'~4 ~,g~a
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed? AIoM~
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL crrY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH SUPPORT-
lNG CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
t
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes No _~ If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (B) Completed legal descril~ion (C) Map or plat of ~e propos~! filling or excavating showing location and amount of m~teri~l
proposed to be removed of deposited, with a description of the area (D) The depth or heights to which such removal or deposition is prolx~ed throughout I$~
area and ~e proposed angle of all slopes to be shown on a 2' contour t~,p at a scale of 1" = 50' or larger: The proposed and origifial conto~n shall be shown in-
cluding afl property within 150' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the Stnt~ of k:;m~ta .(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 O) Public liabili~ insurance.
Amount of bond
Permitfee ~ ~7,O°
Permit deposit
Letter of credit,
or deposit of money
Signature of applicant ~ (~ City Engineer ~'~ ~"~---~//
Permit i~ vat.if signed by Ci~ Engineer.
liability, insurance provided
Date 3/,/~o
Date 3/