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Home My WebLink AboutExcavating & Filling PermitCITY OF PRIOR LAKE 447-4230 Applicant ~ Address: Address: A~ss: Cons~' Permit No. y)r APPLICATION FOR EXCAVATING/FILLING PERMIT Phone # Will the excavation or filling be in a: Watercourse Wetland Upland Purpose for the proposed excavating or filling: ~/~-t&'A,/~-/~-d:dld~/~.~ Estimated start date: ~/~ '~/.tgO ~ C~mpletion date: What is the type of material to be removed or deposited: ~9(.A ~ ~/3/ff~, '"t'~~_,~ ~--.,~'t"',,4.1AII/~,~ In what manner will the material be removed and/or deposited? ]~9/~//A--T_ 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 SI'IAI~ BE THE RESPONSIBILITY 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 CITY OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISItlNG 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 pmpos~ filling or excavating showing location 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 proposal 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 ali property within 150' of proposed excavation or deposition and shall be signed by an engineer or surveyor registered in the State of Mim~oso~a .(E) Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade (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 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 liability insurance. Amount of bond Letter of credit, or depg~ 9~ n~cy liability.insurance provided . Permit fee '~ '''~ Signature of applicant . ~,~-- ~...., ,.~.~ o_- Permit deposit City Engineer ~ M ~-~ ] ~ Date Permit ~s valid if signed by Ci y Engi ee . ----~q~----- REQUEST FOR REVIEW AND COMMENTS / ~0~: C(ll~fll O~ ~ ~pplicltioR Ire ~ g~0~ ~ 0g thit ~ RL~II~ CoaliRell~ to: D~- D~ ~w~ M~ ~ ~ W~ ~ ~ P~ ~ ~1~) FROM: P~ L~, DNR Ama H~ml~ PHONE: ~1- ~2-7917 F~: 651-~2-79~ TO: r~ co~ Di~ (SWCD) ,5 c.o'O- ~~ ~L.P ~ 3 zuuz PROPOSAL. INFORMATION Applicant: ~--~"-~_.~-~-- Protected Water:. COMMENT8 ON PROPOSAL Comments on Project by Reviewer (attach sepmate sheet if needed): Recommendation of Reviewer:. Name of Reviewer:. Title: Date: NA-05620-02 2/16/01 Minnesota LocaVlata/Federal Application Forms for WaterM Projects · """ "-' BASIC APPLICATION Application No. Field 1. APPLICANT CONTACT INFOlIMA110N fSee ~ I): lA. AUTIlOI~.D AGOIT (See H~.P 1.4.1 Name: ~ Complete mailing address: Name: ~'~ Residential phone: Business phone: ( Fax (if available): email (if available): 2. PROJECT NAIE OR TITLE (if applicable): 3. NAME OR I.D. # OF WATER 901)Y/IIOI)IES IMPAC'I'EI)** (if applicable; if known): F 4a. I~l ~ Itl~'Tf]~. (circle one~ NO 4b. ff Yin, what type (if known; circle all that apply): 1 1L 2 3 4 5 6 7 $ ~own~ Title: Mailing address: Residential phone: ( ) Business phone: ( ) Fax (if available): ( ) email (if available)' 1 hereby authorize to act in my behalf as an agent in the processing of this apphcation and to furnish, upon request, supple- mental information in support of this application. Applicant signature Date If YES, indicate size of entire wetland (check one): Less than 10 acres (indicate size: ) 10 to 40 acres /~Gmater than 40 acres $. PliOJ[~ LOCillOIf~ (information can be found on property tax statement, property title or title insurance): 1/4 section: Section: To,hip: __ Range: _ 6. ~OI ii ~~~ (~ appli~ble; ~o~): f~cel ]?g/~o~e:_ ~ 50 ~-q UTM coordinates: easterly A northerly ~, ~ bodies or ~a~dts, attach additional sheets labeled ADDITIONAL WATE~IE$,.]~3/II~x,,EO, ADDITIONAL PROJECT LOCATIONS, or ADDITIONAL LOCATION DESCRIPTIONS. 1 7, ~ ~0 ~ ~0 ~lll: SITE: Attach a simple si~ If needed, include on the map written directions to the site from a known location or landmark. Include lug w~d~street names and numbers. Also provide distances from known locations and any other information that would assist in locating the site. Label the sheet SITE LOC4TOR MAP.. I~. PUI~OSE OF Pl~IIE~rI': ~aat do you propose to do, ~d why ~ R need~? Ple~e ~8. ~1~ {~ D~k k d~ ~hat you pl~ to do ~d ho~ you pl~ to do ~ ~r ~ ~ H~ 10 ~ ~ ~ ~; ~ a~ ~ To I~ page 2). If space ~low is not ad~, a~ch s~ shc~ la~l~ PROJECT DESC~PTION. 11. FOOTI~INT OF IMPACT (ifapplicaNe): Indicate fetal or square £cct) of wetland(s) or water body area(s) to be filled, drained, inundated or excavated; amVor indicate length of stream or river affected (in linear feet). NO ~=::l~'O[//$f/ acrcsor___r_;__, squarcfcet .mi/or I~)O kiSJ.~.linear fcct 12. TYPE AND ESTIMATED AMOUNT OF MATEIIIAL(S) TO BE PIAC~ INTO O[ ~(CAVATED FROM TIIE WEHJOJD OR W~ER BODY (if applicable): List each type of material (such as rock, sand, clay, concrete) to be filled or excavated, and estimate amount in cubic yards. I'1 FIIJJN~ ~ t2fCAVATIN~ Type(s) of material Estimated amount in cubic yards Type(s) of material Estimated amount in cubic yards 13. ESTIMATED PIIOJECT'COSTf~'ff~or 1~. S~{~1~ CON~~: What alternatives to this proposed project have you considered that could have avoided or minimized impacts to wetlands or water? L~ al ~ t~ aRsmalil~ (one of which may be "no build" or "do nothing"), and explain why you chose to pursue the option described in this application over these alternatives. 15. PORTI~ OF WORK ALREADY COMPtEIED:. Is any portion of the work already completed? ./~tO lfyes, describe the completed work on a separate sheet of paper labeled WORK.dLRE/.DY COMPLETED. (See J~I.P 15 16. ADJOINIMI~ PROPERTY OWlet:RS: For projects that impact more than 10,000 square feet of water or wetlands, list below complete names and mailing addresses of adjacent property owners whose property also adjoins the wetland or water body where the work is being proposed. (See ~ 16. If necessary, attach a separate sheet labeled/ID JOINING PROPERTY OWNERS.) Complete name(s) Complete mailing address (including street address, city, state, zip code) 17. STATUS OF OTHER AH~IOI/AI~ List any other permits, reviews or approves roland m ~s proposed ~oject · atm ci&~ ~ or ~ al~ ~ a~ or ~. ~ H~ IZ ~gen~ ~pe of app~vM ID nu~r Date appl~d for Date app~ved Date denied 18. I am applying for state and local aMImrbalion to conduct the work described in this application. I am familiar with the information contained in this application. To the best of my knowledge and belief, all information in Part 1 is true, complete and accurate. I possess the authority to undertake the work described, or I am acting as the duly autho%cd~~thc applicant. · ~ mi~ I~ $ill~nl by the person who desires to undertake the proposed activity (the applicant in Section 1) orby the applicant's duly authorized agent (if the boxed Section lA has been filled out and signed by the applicant). Fmi~ral aalhm~ali~n: Generally, in addition to state authorization, projects in wetland or water areas also require F .eder~., .autho,r!za~on fro.m the Corps o_f. Eng'.m. eers under Section 404 of the Clean Water Act. To appl.y.~t...q:~C~orps using tins appucauon package, the applicant/agent must complete the modified one-page Federal on pa.g_e 4 and mai! it to the Corps (address on Instructions, page 4) with a copy of the state appli~i~: AppliC~"5 may: i,f,th ~ey wi~h, apply_only for.C ~o~ps authorization by using the unmodified Federal applica~','forr~ that" ~s avauame iron] ~;orps othces or ma the Internct at www. mvp.usacc.army, mil ",i ~ -"_.;j;';,,~.]' , '- 3 '.~ (~' ¢~., .., '(.%?/ MapQuest: Maps: print Page 1 of 1 1S4S1 Breezy Point Rd Se ~ Prior Lake, MN SS372-1BS7, US Back All rlqhts reserved. Use Subiect to This map is informational onty. No representation Is made or warranty given as to Its content. User assumes all risk of use. Hapquest and its suppliers assume no responsibility for any loss or delay resulting from such Use. Privacy Policy & Leoal Notices 2002 HapQuest.com, Inc. 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