HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
447-4230
Applicant,
Address:
Property Owner:
/Z~O 5,0'
Phone # 9 Y~/2~.&- lO2/
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: .
Wetland, Upland
Estimated start date: (,,/~. ~'/~ 2}
What is the type of material to be removed or deposited:
Completion date: "//~/6 '~
g,~-'~) ~ /)~.t~ DriP7'
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? ICf]/¥
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 OVERAI~ 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 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 martial
proposed to be removed of deposited, with a description of the area (D) Thc depth or heights to which such removal or deposition is proposed throughout tbe
area and the proposed angle of ali slopes to be shown on a 2' contour map at a scale of 1" = 50' or larger: The proposal and origifal 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 Sine of Minnesota .(~)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade tH} Application fee (I) Bond, I~er 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 o~her public ways
along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything r~uired to be done (J) Public liability insurance.
Amount of bond Letter of credit, or~itor it of money liability, insurance provided
Permit fee Signature of applicant, ]~_ ~.'~..~~ff,,...,~,, Date&/)
Permit deposit City Engineer Date ~
Permit '~/avalid i~f signed by City Engineer.