HomeMy WebLinkAboutExcavating & Filling Permit
L _ _m p
ell'i OF PRIOR LAKE
APPLICATION FOR
EXCA V ATING/FILLING PERMIT
~ Date? I Z? I OL
0-2-:J)- 07
Permit No.
447-4230
Applicant
Address:
~ I m~L ~US~
J SSo ...., CA L-mllT' M t:!, }J g ~
.
~ A7\1~ AI;. UoJg
Phone 1/
~lL LA.,Q!, I h1"-l
Phone 1/ CJfi~ .440 ,~3
5""S37").,
Property Owner:
Address:
Contractor: ~I-Jc.~ Co/,::!...AXr~ ~~ r :DJC
(
Address: J;)..(J:kJ ~~IL ~ NJ[; 1 ~~A:t:siJ;:.1 m....,
Consultant Engineer/Surveyor -3~d. ~ Lc~L
Address:
Loc. fF ~A:ma th A:eoJ6'
abon 0 . ~I' ~rty:
Legal Description: ~ ~b
Phone 1/ qS.J./~.J. . OC1Po
S'Sl7~
Phone 1/
Will the excavation or filling be in a: Watercourse
Purpose for the p. WI' ...~ed excavating or filling: -a
-.SJ e.~u ~)~...v,-~-.,so~..
Wetlanrl Upland
Ra. ~~ w.J-,fo( ::.r:./IIi.~dS
Estimated start date: ~C:7"\JS1"" 7! ;;l..o~"')...-
A-u6vsr 9. :J...c16~
What is the type of material to be removed or deposited: _
Completion date:
&k)C~
c.<HJc~ ~ &~ ~~Wcur~
,
hLJ~
In what manner will the material be removed and/or deposited?
.,...~~ ~A-~ ~ #1u>~ & Dc.....,- ..z::N-:n
What highway, street, or other public way will material for removal or depositation be hauled or carried? Dl J ~ 4- J- ...p I ~
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 APPUCANT TO DEMONSTRATE TO THE SATlSFAcnON OF THE crry
ENGINEER POR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCA V A TlON AND/OR FlWNG COMPUES WITH THE OVERALL crry
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 KIf
yes, show 1" "'I'W~ effect.
SUBMISSION REQUIREMENTS:
(A) Completed application fonn (B) Completed legal description (C) Map or plat of the r ' . r ...:at filling or excavating showing Icx:ation and amount of malerial
r . r .,~ to be...... led of deposited. with a description of the area (D) The depth or heights to which such, .. II or deposition is r . r .,~ throupout the
area and the r' "r "~ angle of all slopes to be shown on a 2' contour map at a scale of 1" = SO' or larger: The r" "r ..~ and orilitial contoun shall be shown in-
cluding all r'''r-''/ within ISO. of proposed excavation or deposition and shall be silned by an engineer or surveyor registered in the State ofMi"" ~". ,eE)
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. hilhways. streets or other public: ways
along designated routes of travel and to pay such expenses as the City may i nc:ur by reason of doing anythinl required to be done (J) Public liability insurance.
Amount of bond
Permit fee 2-5.5"0
Letter of credit. or deposit of money liability insurance provided
Signature of applicant ~ "On~, ~ / Date .2IJ.:J./6 ).-
City Engineer A (- ~ - Date 7/2 <01 O~
Permit is ~~ed by City Engineer.
Permit deposit
pa,c\ 1-1-~- 02-
~ G~~ 32-\(.0
!7 "+ 23~