HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
447-4230
APPLICATION FOR
EXCAVATING/FILLING PERMIT
~.-~ 0.L., Date 0
Applicant
Address:
Property Owner:
Address:
lq/o?-..
Phone g
Contractor:
Address:
Phone
Consultant Engineer/Surveyor
Locatio~ of~openy: ~,-.,',~_.
Pho ne #, 4a¥'1 -
Legal De ~s~iptiOn:
Will the excavation or filling be in a: Watercourse 1,2 Wetland ~ Upland
PurpoSe for the proposed excavating or filling: ~ ~--~.t ,,,a~:=,~ ~t¢..-~-~..~__~.T.
Estimated start date : (¢'/St//0~. Completion date: ~tO~l~/~l
What is the type of material to be removed or deposited : l~.,a,~-.,~.- F::tt..,-.~ ff'~c.,~,~,,~."')
In what manner will the m,~rial be removed and/or deposited? ~~:'~'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, fight of way, thoroughfare or public ground will be obstructed? IQ
IT SHALL BE THE RESPONSHilLITY AND TIdE BURDEN OF THE APPUCANT TO DEMONSTRATE TO THE SATISFACTION OF ~ crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES wrrH THE OVERALL CITY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHXNO OF A REPORT ~ SUPPORT-
mO CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes No v/ 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 location and amount of
proposed to be removed of deposiuxi, 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 ali slopes m be shown on a 2' contour map at a scale of 1" =50' or larger: The proposed and origirial 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 Mkmesota .(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, struts 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 /t9/~ Letter of credit, or deposit of money liabilityinsurance provided /,-1/~
Perrnitdeposit ?J/tN City Engineer.._ "~t..~ I~C ~ t)L,-,..,,t~ Date
Permit is valid if signed by City Engineer.