HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
APPLICATION FOR
lq
4474230
Applicant _~ LIL- ~lCal/--I ~'
Property Owner:
Address:
Phone
Contractor: ~ A ~, I:s~-"~,~
Address: ~
Consultant Engineer/Surveyor
Phone
Address:
Will the excavation or filling be ina: Watercourse Wetlamt
Purpose for the proposed excavating or filling:
Estimated start date: 7" I '7- O ~-- Completion date: '~ - $ O - 0 2-
What is the type of material to be removed or deposited: I..- '~slE~ ~-
In what manner will the material be removed and/or deposited? ~ff-g~ L~no~-~,-.., ~J'~s
exrr osto&- .uatd
What highway, street, or other public way will material for removal or depositation be hauled or carried? !~--~-m~
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 SATISFACTION OF THE CITY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERAI.,L
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHXNO OF A REPORT WITH SUPPORT-
IN(} CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan7 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 Incation and amount of mamial
proposed to be removed of deposited, with a description of the area (D) Tbe depth or heights to which such removal or deposition is proposed thr~_ghom 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 origiml contours shall be shown in-
cluding all property within 150' of proposed excavation or deposition and shall be signed by an engimer or surveyor registered in the State of M;ones~a .(E)
Erosion control plan (F) Affect on existing utilities (G) Protection of site by erection of suitable fence, guard or barricade Od) Application fee (I) Bond, letter of
crediL or deposit of monies in a sum sufficient to pay ~e cost of restoring a site. The extra ordinary corn of repairing, highways, streets or other publig 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 insuranco.
Amount of bond
Permit fee Z3.~'O
Permit deposit
Letter of credit, . or d~C~ey ...,," liability.insurance provided
Permit i~aiic~if signed ~y City Engineer.
TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
DATE
ADDRESS '~O
OWNER
PHONE NO.
I-I FOOTING
[] FOUNDATION
[] FRAMING
[] INSULATION
~..J~INAL
[] SITE INSPECTION
CONTR. /Z~ / / ~9~C~.~
[] PLUMBING RI ~..EX/GRAD/FILLING
[] MECH RI ~ COMP~INT
~ WATER HOOKUP ~ FIREP~CE RI
~ S~R HOOKUP ~ FIREP~CE FINAL
~ PLUMBING FINAL D GASLINE AIR TST
~ MECH FINAL ~
COMMENTS:
~I~ORK SATISFACTORY, PROCEED
[] CORRECT ACTION AND PROCEED
[] CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector~~::~------~"Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI