HomeMy WebLinkAboutDriveway Permit #12-D-19 � �
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"EXHIBIT B"
• FOR CITY USE ONLY
DRIVEWAY PERMIT PERnnrr# j _ _�
DATE �D /Z
APPLICANT NAME: PI{i�� i✓ I��O 1�1
OWNER NAME: Ji�n �►'6'�"►G�1 1636W� d' �e��D� �c.e� (63+'+0
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PROPERTY ADDRESS: �O 3 G�'� " G 3�0 Gon roy S-� /�� $�O`^�� d���'"�
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TO CONSTRUCT: ❑ New 1 9.Replace ❑ W i den
TYPE OF PROPERTY: (�.Residential ❑ Commercial ❑ IndustriaF
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Proposed width of temporary or permanent driveway �� (Please provide sketch on reverse side or on separate sheet)
Type of Material IQSiJ�o���
Is property within the Shoreland District ?�.Yes ❑ No (If yes, applicant must submit impervious surface calculation)
The driveway is proposed off what roadway? �a►hroa $l� ��
Is driveway shared by another property owner? � Yes ❑ No (If yes, signature of all parties is required)
Estimated Start Date ���/d �� �-
Estimated Completion Date /a�Za�/�L
SKETCH REQUIREMENTS
1. A driveway sketch is required as a part of this permit. The sketch can be drawn on page two of the permit or on a
separate sheet. The sketch does not need to be drawn to scale, however dimensions must be provided on sketch.
2. Driveway sketch should include proposed driveway, existing driveway (dashed line), driveway dimensions, property
lines, dimensions of driveway from property lines, building locations near driveway, arrow indicating north, surface
features near proposed driveway location (trees, hydrants, utilities, etc.).
3. If on a comer lot, the sketch should include dimensions to intersecting roadways.
CONDITIONS OF APPROVAL
1. No work under this applica ion is to be started until application is approved and the permit is issued.
2. Where work on traveled roadway is necessary, traffic must be protected and flags, signs, safety cones and proper
barricades must be placed in accordance with safety procedures.
3. No foreign material such as dirt, gravel, or bituminous material shall be left or deposited on the road during the
construction of driveway.
4. Road must be swept clean after work is completed.
5. Prior to.placement of concrete or bituminous surfacing, the applicant shall notify the Engineering Department at 952-
447-9830 that the work has been completed and is ready for final inspection.
6. No changes or alterations in entrances may be made at any time without written permission from the Engineering
Department.
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7. Permit expires 90 days after approval date.
8. Additional Conditions
fMPORTANT: Before startintt work . . .
The Applicant shall call Gopher State One Call (1-800-252-1166) 48 hours prior to starting work. Applicant must call the
Engineering Department (952) 447=9830 for inspection 24 hours prior to time of inspection.
As provitted in Ordinance Numbers 1107.205 & 1 Y07.206 I, We the undersigned, herewith make appliCation
for permission to construct the driveway at the above location, said driveway to be constructed to conform
with the standards of the City of Prior Lake and to any special provisions included in the permit. It is agreed
that all work will be d�e to the satisfaction of the Engineering Department. It is further agreed that no work
in connection with this application shall sta'rt until the application is approved and the permit iss ed.
P/�!� I ' : ,8/a ��v.tic►
Coi�tractor ApplicanYs Signature
j , Date: ���8 � '�-•
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FOR CITY USE ONLY ._
' AUTHORIZATION OF PERMIT
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Permit Fee $ � '
In consideration of agreement to comply `in all respects with the regulations of the City of Prior Lake covering such operations, and
pursuant to authorization duly�given by said City of Prior Lake, permission is fiereby granted forthe work to be done as described in the
above application and submitt�d drawi gs, said work fo be done in accordance with this application and'submitted tlrawings.
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. , ,�,r�C/ Date ���� /�'
ENGINEERING OFFICIAL
4 Permit is valid if signed by City Official
Permit Expiration Date (90 days from approval date)
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