HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
APPLICATION FOR
EXCAVATING/FILLING PERMIT
Permit No. ~-'~,~"' / 7 Date ] '),, /~C7, /~
447-4230
Contractor: .~ _ ~__ . ~o~
Consultant Engineer/Surveyor ~Of~ ~ ~/~ Phone
Will ~ ~xc~v~tio. or ~lli.g ~ i. a: W~rco~ Z Wetl~d Upl~d
~,e for ~e pro~ excavating or filling: ,. ~'~,f~d ~'' O~ ~
Estimated startdate: ,~-~ ~'-aZ Completion date: /Z-
What is the type of material to be removed or d~.~x~iit~: ,d'/'~'~^,.
In what numner will the material be removed and/or~?
What highway, street, or other public way will material for removal or deposilafion b~ hauled or carried? /I% b
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 SATISFAC'rION OF THE CTrY
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 Ot) Completed legal description (C) Map or plat of the proposed filling or excavating showing location and amount of male. rial
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 larser: 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 MMneao~a .CE)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or ban-icade (H) Application fee (I) Bond, letter of
credit, or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra ordin~T costs of repairing, highways, streets or other public ways
along designated routes of travel and to pay such expenses aa the City may incur by reason of doing anything required to be done (J) Public liability insutanee.
Amount of bond
Permit fee 3 ~
Permit deposit
of money
Letter of credit, or deP~2sit ___...__. liability.insurance provided
of applicant ~~g~~~~~ Date/,~'~' "~---
Signature
Permit ~s v signed by City Engineer.