HomeMy WebLinkAboutDriveway Permit #11-D-13 DRNEWAY PERMIT APPUCATION
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' F � PERMIT # I �'�� jJ
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� DATE: � "'�
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M��rs�
. leoa orflce use oN�h
TYPE OF PROPERTY: �.,@esidential ❑ Commercial q Industriai j I //�
APPLICANT NAME: _cl��` _ C,(1��-� Lt�,`_'�� C To►J�' �L[1czWl� � ! `J � �d V ��^ O ! `'� �)
OWNER NAME "
PROPERTYADDRES3: �� �L1`aSl,xY'67 I�TLf_/_C- t,l J
��� Y�C�R. C��� �".+ G.� MProvetl ey:
DRIVE APPROACH
TO CONSTRUCT: � New ,�teplace ❑�den ��8�
2.�.� wide (TEMPORARY ERAAANENT rive aPProach Fee:
� /t (Pbaa D�� ��h on rcvarss Nds or on e wpmate aheat) �.
�'. . Type ot Material ��.:. t _��-� Z° `� - ,:.. ... . � � , . . . . .. � . . �
. .. . ��:RE�UIREMENT5 � . � .� � �� � .
1: No work under this application is to be started until applFCetlon Is e�roved and the;pertnit is issued:
2. Wh9re c+rork on Vaveled roadway is necessary, traffic mus� be profected and flags, signs, safety cates and propgr
barricades must he pfaced in acoordanCe WitFt safety procedures.
3. No faegn materiat;such as dirt, pravel, or bituminous materfal sh211 be bft ordeposited i5n the roatl during the :
conatructlori of ddveway.
�� 4. � Road mpsC be swept�cieao aRer �rk ia compfa�d. �� �
� � 5. Prior to placemeM W concrete or bkumirwus surfacfng, the applicsnt stiail noliry the Eng(neering peparOmeM thffi�:the � � �
wcrk has been completsd and ls ready for flnal jnepection:
B: No ohanges or alteratlons in enUances may be made et any time wiUtWt written oermission Jrom the F�ineetir�
DeParkm@nt Vr inspector.
IMPORTANT: Beion startl�w work . . .
The-Applkant shall call Gopt�er State One Call (1-800-252-1186j 48 hours prfor to siartlng vaark. Appii�ant must cail the
En inegring Department (952) 447-9830 for fns fon 24 hours prior to time of insR��•
Wherr widening or construcUog new drivaway approaches a$10.00 fee is required at the time of epplfcadon.arni a sketch Of ihe
� �� property depkti[ig preaent antl: proposed tlriveways in reladon to the property line�. �� �� �� � � ��
. . . . . . . � (Sketch�. on re�6rse side M applicatlon a provide a seperete pian) ;�� '� �� ��..�..
As provide in 4rdinanCe Numbers 11Q7.205 & i 107.206? ,I, We the untlersigned, tierewlUt make apppcaqon
for permis�on to eonstruct the drivsway at the ebove Iocation, said ddveway to tie constructetl to coMortn
with the sfandards nf ihe Cfty of prior Lake antl to any special provisions included in the permR. !t is agreed
that ell walc will be done to the sadafaction of the Engineering Depattment ft is further agreed Shat no work
In connectfon with this appllcAtion will be started until the application isap�roved ant! ih9 permif issued.
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Contractot ApplicanYs Signature
Date: ('a'�f�'� ��
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