HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
0o~_ ~J -// Date ~
,/ l'5/,
447-4230
Applicant
Address:
Property Owner:
Phone
Phone
Address:
Address: ,, ~"~/tgr7 /~ ~'
Consultant Engineer/Surveyor /~/,~
Address:
Phone #
Location of Property: /~'-'~ ff 7 ~'~j~ "~"/~ C~
Legal Description: i~ _z~ ~ ~ /~,~...,~
Will the excavation or filling be in a: Watercourse Wetland
Purpose for the proposed excavating or filling: ~,-~'-/~-~e~ ~, ~ al
Upland
Estimated start date: ~t/t~ ~
What is the type of material to be removed or deposited:
Completion date:
In what manner will the material be removed and/or deposited?7/'P~ ,
What highway, street, or other public way win material for removal or depositation be hauled or carried? ~ ~- ~'~
What, if any, street, avenue, lane, alley, highway, fight 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 THE 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-
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 lecation and amount of material
proposed to be removed of deposited, with a description of the area (D) The depth or heights to which such removal or deposition is proposed throughout 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 origifial contours shall be shown in-
cluding all proper~ within lSO' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of Mlnneao~ .(E)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade iH) Application fee (I) Bond, Icier of
credit, or deposit of monies in a sum sufficiem to pay the cost of restoring a site. The extra ordinar~ costs of repairing, highways, str~sts or other public
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 liability insurance.
Amount of bond '=='-' Letter of credit, "=--' ..... or deposit of monev~ '='=" liability.insurance provided '"'-'=
Permit fee ~--~,~'~ Signature of applicant ._~/~,~. _~~..--- ' . Date
Permit deposit City Engineer t,e'-O- Date , ~ {
Permit is valid if signed by City Engineer.