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Excavating & Filling Permit #12-G-09
� I � Q# *�u� � ��` � ' '�°"�'°•> "�XHI8t3' A" � I F#7R CITY USE bNLY � EX�AVATING AND GRADING PERMIT � ���n���r � � �,. -�. 'n I n�r� rt � � ! . ( �t��a�,r. P�`.�a t�.l�e -� 5 r'�r�-- L,��.k.e 1�vc�rtl�o.,ot �no«re� �� S-� Z1 �'9 { Projee�lE'k3rr�tQpmen# hlame if Appiicabl�: � Addresst #'�`1��D C.1? W1iM$YC£ �'1,J� f��, "� "�fOC� • �ic►.r �..�..�..: . , - �"oe.l d 1/i�t4>T�e k+�r ► C.'t�,uc.k �Je� P�o �93'�•�2?.b-"�u,�`S'' . Properiy t3wnec: �.� i Addr�ess: '`��T '�Avi� Cr�r„�e � �� �"�`�oS� +�Ot�J� ri� u � ,'�.,� �'��-3SDZ GOt1�fi8C�01: J '.SCA ��� Ci�� PI10118 #�y�,.[„�' � eS Ad€ftess: �b� � � .+J �' #.' A#l� (e 0 � t Gonsultanf Eng3neer/Surveyor: GvK4�;1 *.�70.VZVt�r p� phQne# 3 ��"� �4� Address: '£�L.�IW� 14�D� GoW�wti�+c� �'kv�C-����pb;� �io�r'1-�....ir.r�. �mergency Contact (24 hr): �Y�l�ti �'t!W'@JVt � Phane# �2+C? --�2"�-do$ � » �ocat`ron or Property: Z��7 +� 2•�+fa�,�" ✓,rJ �t r�A f.A�ke. �.� � ��galDescripttor►:..�._.�lL1 # �5t�3+G�lNI�, �-5�33P8�'Q �,or_�q1�e'`��ownsil�+d Ala�" - Wiil #he excavatton or filling be In a: Watercourse �. Wetland EtpEand Purpose for the proposed excavating ar tilling: '� �C "�i - +t ��V#'� Estirrtated slart date; �oY• 20 {2. GompfeBon date: 1�o�t« 2Ol2 CNS$1 ts'►�`► What Is th� type af material to be remaved or dep�ited? U� C+o ir V.�a � u�, plat sc� What is ihe quantity of material ta be remaved Gr d$posited? ' rx v�. �(� VUf�at ts the tot�i area tlisturbed far $xcauatian or filling? �►and in w1�at manner wiMf ti�e rnaterial be removed andlor deposifed? w t What highway, sireet or othar public-way will material far remova! or deposition be ha�led or c�rrled7 Ounn� �'� What, if any, street, avenue, lane, alley, highway, right af-way, khoroughfare or publie ground will be obstructeci? , srw�t\1 p ow��" ��in8 �14} IT SHALL BE TH� liESP(71VSlBiLITY AND TH� Bt1F2t}EN OF TFiE APFLICANT'FQ G►�MQSJ5TRATE Ti0?HE SATISFAG`fi(?N �F THE CITY ENGINEEI2 FOR THE GITY OF PFtIOR IAK� 1'HAT 71iE PROPOSED EXCAVATIQN ANI7/0R FILUIVG Ct7MPLIE� WITH THE OVERALL CITY {?F PRIOR LAKE STORM WA7ER MANAG�MENT PIAN. SAIQ 8UF2DEN SW1�CL � lh1CLURE THE FURNISHING OF A F2EPOF2T WITN SUPPORTfNG CAlCUlATIONS 4F A REGISTERED PROFESSIONAI. � ENGINEER. i Will ptoposed excavatian ordaposition affect #he City of Ptlor l.ake overall storm water m�nagement ptan? Yes No � � If yes, exptaln proposed effect SUBMISSION REQUIREMENTS: ��� ��� ��� t'�2�Y+�OVin+� CAv�t�}+eC.kt�„nk� (A) Compteted appl�cation farmi � � {B) IUlap ar ptat of the proposed filling or excaval€ng showing lacation and amount of mateaal proposed to'be remoded dr dsposited, with a dssCrip�ion of fhe area (C) The depth or hetghts to which such removai ar deposition is proposed throughout fhe area and the proposed angle of all slop�s to tae shown on a 2' contaur map at a scale of 9"=50' or larger. Tfie prapased and original contours shall be G:UdminlPWtks�Mmn�a112Q47P1YllMUPDATE�EXit�TfAAPPLtCA4[O�IFOREXfiAV&:FI1 � �� W{F ���AII� � �SC�1Y�� .. .... .. ....1 a'� r �Q� � � �+��n* `{EXHIBIT A" shown inclutling a!i praperty within 200' of proposed excavation 4r deposftion and shall be signec� by an engineer or survey4r regtsterecf tn tha State of Minnesnta (a} �rasioncont�o�plan -- pra�� ,�,oyv►pr�sf�d �u o� day lt►�d� �►�"tocv �v�'tia�t�►s anly (E) AF(ect on existing utilitles {F) AxtAltcati�n fee (G) Amount of l,etker of Cted�, or deposiE of monies fn s sum sufficiertk to pay the c+os# of restoring a siie. Tfie extra ordinary costs of repaising, high►vays, streets or cat�rer public ways along designated roukes of iravel and to pay such expenses as the Gtty may incur by �easan of daing anything �equiretl to be dona {H) Public tiability inst�rance GOt+1Dl'fIQNS dF APPRZ7VAl: t�) aAP must call the Enginae�ng Department fnr erostan car�trot 3nspection at (952)447-9834 prior ta earttt m�ving ackivities. {2) Maximum 4;4 slopes are ailowed in'maintainetl' areas exoepf apptoYed by Ci#y �ngineer. Ma�cimum 3:1 slopes a�e allowed adjacent natural resoutoes, (3) `Slopes gr�atar than or squal to 3:1 sfiall have approved erosion control �sst Managem�nt Prac�ces installed Im�nediately after fin�hed grading. (4} Minitnum grade for dreinage swaCes sha11 b� 2�fn �r greater. (5) Removal or deposi�ing of materi�i greater than �4Q0 cubtc yards requires a condillonai use pemtlt, u�less it is pa�t of a pretiminary plat applic�tion. ��� Amp�ed to �ihe Eo�ll DNR, t Corps 4f E gineet�, Priar�k e/SAring �Lake Wat eshed D Estrict,�Scott Co nty MN1D0?t MPGA. {7) A�iplicanl is responsibls #ot afl damages to ather property �r (acilities as a result of worit caverad hy this permit. {8) Applicant must call the Er�}ineering Uepartment #or firtai grading insp8ction at (952)447'�830 Prlor to release of gratltng securiiy. � (9) Addittonal Condltions , 7'H� LINDER�a1�NED H�RE1N CERTiFY THAT TH�Y HA1/E REA� �ECTION 708 C3F TNE GI"E'Y CbDE AND ACC�PT' THE TERMS AND GONp1TIONS 1'a 7HE ISSUANCE 4F THIS PERMIT AND AGREE TO FULLY G4MPLY 7HEREWITN TO THE SATISFAGTiON 4F t-lE C1TY O� PR1QR IAKE EN(31N�EfiING DEPARTM�NT Oft li'S DESIGNATED AGEN7. Applicant: • � Date (�� �� 1� ; � _ " 1�ate ...�l�.-� Property Own - �� � �� � -' ,. i � , � � _� .�- FOR CITY US£ ONLY .�� ` f ,�"�� � '�,' �'�' ' =�-- " . � .... .•� AU7HORIXF►TiC?N OF P�RMIT ,' ` �q' � Lei#er o[ Gredit, Bond, or Gash) FinanGiai Guaraniee'Arr►nur�f $ Financial Guarantee Typs ( Perr�it �'�e � l�abiliiy insurance pravided7 Ci Yas� No (insurance Certiftcate musi narr�e the City of Pri�r Leke as an addfkional insured party) In eonsideration of agreement to oomply in ai! respeeta with kire regutations oP the Gi�r af Prior Lake covering such operabons, and puqsuartt to auihnrizatlon duty given by said Giry uf Priar L�ke, permission is t�erelay granted !or the work to be done as des�tibed 9n ths above Application ar�tl submitted dtawings, said work to be done in accordance with this application and subtr�itted drawir�gs. ENGINEERWG OF�ICIA� . � I�ate � � Pemiit is valid if signed by City Ofliclal Perm�t Expiratian Date Planning Dept. 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