HomeMy WebLinkAboutExcavating & Filling Permit #12-G-03 a � PR7p
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"""'"�y"" "EXHIBIT A"
FOR CITY USE ONLY
EXCAVATING AND GRADING PERMIT PERMIT #-� J =-�
DATE �-y-��
Applicant: __ . l71' ��( �/i nn�� , Phone # ��'� �� � �� 1 ��
Project/Development Name if Applicable:
Address: � �� � Yl ar�t ,�, � 1�2. Pf?Or' � MN
Property Owner: �i � ii-h W.e�h Phone #
Address: L� 11 Q.. �a►.-Rl.r�..l � iO-•L.�� �- 17a...iom,... �� - M N
Contractor. L. c�,.c�sc.�p� � r.►4,�,,��..� ,.Ss Phone # �ia'1 • lo�i .�-7 � 2
Address: �S�-9 �•�l C�rt�'` S-t .- NoR.�ln� i LI 1- M nl ^�j S o S'�
Consultant Engineer/Surveyor: Phone #
Address:
Emergency Cor�tad (24 hr): �1� � �:�Nt�►� Phone # L •15 2°I I• D�OS
Locafion of Property: _ �?� �� /IIIA�/� ( � 1 � T � �' � /YM�
Legal Description:
Will the excavation or filling be in a: Watercourse WeUand Upland
Purpose for the proposed excavating or filling: i�n' Oa+ �
Estimated start date: __� 7�0�� Completion date: V+ �S
What is the type of material to be removed or deposited? ��U �� nr. ei'r�C, j WIAS d►ci. IZMo����. W�erc �� ►5
What is the quantity of material to be removed or deposited?
What is the total area disturbed for excavation or filling? �c9 '7
In what manner will the material be removed and/or deposited? ..-,
What highway, street or other publiGway will material for removal or deposition be hauled or carried? / ,
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 APPLICANT TO DEMONSTRATE TO THE SATISFACTION
OF THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION ANDIOR FILLING
COMPLIES WITH THE OVERALL CITY OF PRIOR IAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL
tNCLUDE THE FURNISHING OF A REPORT WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL
ENGINEER.
Will proposed excavation or deposition affect the City of Prior I.ake overall storm water managemerrt plan? Yes No /V
If yes, explain proposed effect
SUBMISSION RE�UIREMENTS: •
(A) Completed appliqtion form
(B) Map or plat of the proposed filling or excavating showing location and amouM of material proposed to be removed or
deposited, with a descripfion of the area
(C) The depth or heights to which such removal or deposfion is proposed throughout the area and the proposed angle of
all slopes to be shown on a 2' oontour map at a scale of 1'=50' or larger. The proposed and original contours shall be
G1Admin�PW Design Mamwl\2007 PWDM U1�DAIE�EXI�Tf A APPLICATION FOR @CCAV & FILLING.doc
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In consideration of agreement to c�mply in all respeds 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 hereby granted for the work to be done as
described in the above application and submitted drawings, said work to be done in ac�cordance with this application and
submitted drawings.
ENGINEERING OFFICIAL Date S y- I 2-
Pertnit is valid it signed by City Officiat
Permit Expiration Date ����� Z.. Planning Dept. Initials �
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G: W�in1PW Deaign Manua1�2007 PWDM UPDA7E1EE7CFflBTT A APMdCATION FOR EXCAV 8c N7LLING.�c
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