HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
447-4230
Address: ~:7,~ ~t-o'r'l,/,t(~,', /~, ~ ~
Property Owner:
Phone #.
Address:
Contractor:
Address:
, Phone #
Consultant Engineer/Surveyor
Address:
Phone #
Location of Property:
Legal Description:
Will the excavation or filling be in a: Watercourse
Purpose for the proposed excavating or filling:
~at is ~e ~ of ~tefi~ to ~ remov~ or de~sit~:
Wetland Upland
In what manner will the material be removed and/or deposited?
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 RESPONSmlLITY 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 crrY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHINO 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 CB) Completed legal description (C) Map or plat of the proposed filling or excavating showing location and amount of ma~.tial
proposed to be removed of deposited, with a description of the area (D) Tbe depth or heights to which such removal or deposition is proposed throughout the
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 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 M;anesotn .(E)
Erosion control plan (F) Affect on existing utilities (G) Pro~ection of site by erection of suitable fence, guard or barricade (H) Application fee CI) 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 liabiliv/imuranee.
Amount of bond
Permit fee
Permit deposit
Letter of credit. ~ ~e provided
Signature of applicant ,, ~/ Date 7-/-~
City Engineer ~ ~,,~----"'~'~'-- Date ~/II/
Permit is if signed by City Engineer.