HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
~J ~) 7 Date 7
447-4230
Address: I Cyq..q 0 ~_~-~ ~ ~
Property Owner: ~,~~
Address:
Phone #
Phone
Contractor:
Address:
Phone #.
Consultant Engineer/Surveyor
Address:
Phone #
Location of Property:
Will the excavation or filling be in a: Watercourse ~.) · Wetland
Purpose for the proposed excavating or filling: h rs,~r0 ~.. i,oo~[ K
Upland_. kJll~..~
Estimated start date: 7-t (o .-O~'
What is the type of material to be removed or deposited: ....
Completion date:
In what manner will the material be removed and/or deposited? ~:o~
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 TIlE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPUES WITH THE OVERALL CITY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT WITH S~RT-
lNG CALCULATIONS OF g 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 he removed of deposited, with a description of the area (D) The depth or heights to which such removal or deposition is proposnd ~hroughout th~
area and the proposed angle of ali slopes to he shown on a 2' contour map at a scale of 1" = 50' or larger: The proposed and original contours shall he shown in-
cluding all property within 150' of proposed excavation or deposition and shall he signed by an engineer or surveyor registernd in the Stat~ of V. ia,~sota
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade (i-1) Application fee (I) Bond. lettm' 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 (I) Public liability insutam~.
Amount of bond
Letter of credit,
or deposit of money
liability insurance provided
Permit fee
Permit deposit
,Signature of applicant
g:,..
City Engineer . ?';' .~..~
Permit is '~alid if signed by City Engineer.
Date
Date