HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
O-J,~-~/ Date /~ /.
// /
447-4230
o , Own r:
Contractor:
Address:
Phone #
Phone
Phone #
Consultant Engineer/Surveyor
Phone #
Address:
Legal Description: ,
Will the excavation or filling be in a: Watercourse
Purpose for the proposed excavating or filling:
Wetland Upland
What is the type of material to be removed or deposited:
Completion date: ~'//~ ~/4 ,--%
Inwhatmannerwillthematerialberemovedand/ordeposited? ~f) b 60.'1t.. '"ID ~)Or~ p
What highway, street, or other public way will material for removal or depositation be hauled or carried? ~ ~/ff. eo ~/.~
What, if any, street, avenue, lane, alley, highway, right of way, thoroughfare or public ground will be obstructed.'? /lY~/~~
IT SHALL. BE THE RESPONSIBILITY AND THE BURDEN OF TIlE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF TIlE crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL CITY
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.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes No If
yes, show proposedeffect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (B) Completed iegnl description (C) Map or plat of the proposed filling or excavating showing location and amount of malerial
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~ throughom the
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1" := 50' or larger: The proposed and ori~ifial contonrs 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 Sta~ of Mieneaota .(E)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade (H) Application fee (1) Bond, Icier 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, streels or oiher public whys
along designated routes of travel and m pay such expenses as the City may incur by reason of doing anything required to be done (I) Public liability Lnsurance.
Amount of bond
Permit fee
Permit deposit
Letter of credit ...... or deposit of money liability insurance provided .-.
Signature of applicant '~-~~~ ,,. Date ~f"/// {53
City Engineer ~0-~ ~"~~~~ Date
Permit is valid if signed by City £ngineer.