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FOR CITY USE ONLY
DRIVEWAY P���IT PERMIT # ��3 -,,L -
DATE �e��� �
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APPLICANT NAME: �-�! � �
OWNER NAME: G—/� / � G1��
PROPERTY ADDRESS: � �� � � � IGt �.- 1�/��• ,�� �
TO CONSTRUCT: ❑ New ❑ Replace �1 Widen
TYPE OF PROPERTY: ❑ Residential ❑ Commercial ❑ Industrial
Proposed width of temp rary or permanent driveway ���_ (Please provide sketch on reverse side or on separate sheet)
Type of Material � � L
Is property within the Shoreland District ?❑ Yes �No (If yes, applicant must submit impervious surface caiculation)
Tne driveway is proposed off what roadway? .
Is driveway shared by another property owner? ❑ Yes �(No (If yes, signature of all parties is required)
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Estimated Sfart Date
Estimated Completion Date�Q' � / (� �
SKETCH REQUIREMENTS
1. A driveway sketch is required as a part of this permit. The skefch 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, buiiding locations near driveway, arrow indicating north, surface
features near proposed driveway location (trees, hydrants, utilities, etc.).
3. If on a corner lot, the sketch should include dimensions to intersecting roadways.
CONDITIONS OF APPROVAL
1. No work under this application 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 piacement 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 writfen permission from the Engineering
Department.
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7. Permit expires 90 days after approval date.
8. Additional Conditions
IMPORTANT: Before startinq 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 provided in Ordinance Numbers 1107.205 & 1107.206 I, We the undersigned, herewith make application
for permission to consfruct 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
work will be done to the satisfactio of the Engineerin Department. It is further agreed that o work
nnection i h' a plic , ion shall until the applic #ion is oved and the permit issu
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Contractor Applica s Signature
���'� ��Date: �
FOR CITY USE ONLY
AUTHORIZATION OF PERMIT
Permit Fee $ .,_ ��y � V��
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 hereby granted for the work to be done as described in the
above application and submitted drawings, said work to be done in accordance with this application and submitted drawings.
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ENGINEERING OFFICIAL , � , Date C/I '�
Permit is valid if signed by City Official
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Permit Expiration Date (90 days from approval date)
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Concrete wWw .southsuburbanasphalt.com 8 4 8 9
Pet;o, Steps South Suburban Asphalt
Sidewalks _
NEW WORK - OVERLAYS - SEAL COATING ���,,;,,� �u�
20455 Huntington Way, Prior Lake, MN 55372
(952) 447-8698
EMAIL southsuburbanasphalt@gmail.com ��J� � �t��� � '�S
DRIVEWAYS PARKING LOTS PATHWAYS
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Proposal Submitted to: s� � _, �� `
Street: �'�� � �� �'� ���� , � r �' / /U � Phone W
Ciry, State, Zip ��+�� � �� • '"' �I/ Phone��� � ��,T ��j9/
Property to Blacktop
Directions
Scope of work to be done:
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Bid ($ )
NOTE: This proposal may be withdrawn by us if not accepted within � r� days. _�"�� W
ACCEPTANCE OF PROPOSAL - rns above priees. spxit�cetions and A � a ��
conditwns aro saGSlactory and are �srepy accepted. Vou are auVwrized Io do t�e SIOnNUn Qv"�" T�
work as specilied. Paymenl will Ea mads as outline above bid. p�ym�nl dw on �� 763 ��� ��✓� ��
� '�°�'°' Acceptance of Proposal rer� ers t is form an INVOICE
o.�. � Accep�anca Please pay from this invoice no Statement will be sent.
.Cuslo�r S�qnalws
NOTICE OF LIEN: Norma�y Ii�ed anar 3o days, with bga� costs added
P�rsons ol tanvaross lum�shmy labor o. ma��ruls lor IM xnprowment ol r��l prop�Ay may �nlwu � Irn upon IM imprw�d I�nd il tMy ��� not p�d tMir coMriEulions. �wn il wM p�AN�
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IM Complsbon ol Such �mprovsmanls u�iess �ns conl.�clor luman�s Io V» own�r w�N�a ol cl�nn� la rn�eMmcs M�n �ipn�d Dy pnsons wM Iw+tiNrd �ny 4ba a�Nnd lor tM
. � improvemeM and w�o prov�dsd Ihe ownar wilh IxMly nolic� .
� Compie��on Oai� .
� ... No��ca Da�n �men� �o Rb Lun � DH� Lwn fiNd �
White - South Suburban Yellow - File Pink - Cus�omer
........ .......... ........ ..,...... ..........
SUNSET HOMES CORP.
CONSl1L11N(3 EN{�INEERS�
p0�� � PUWNERS and LAND SURVEYORS RROJECT Nb. 933Z.��
NGINEEAING . gooK 2��
COMPANY„ tNC PAGE � 70
�___._____ 100Q EAST 146th 57REET. BURNSIALLE. MINNESOTA 55337 PH 4,j2--3000 �
_. . CERTIFICATE OF SURVEY
Lega Descnption LOT 5 BLOCK 2 MAPLE HILL. 2ND ADDITION
SCOTT COUNTY MINNESOTA.
, C.$� � �' DEN0�5 QCISTING ELEVATION
�8L�9� � �ENOTES PROPOSED ELEVATION
�.---- INDICATES DIRECTION 0� SURFACE DRAINAGE
� FlNtSHED GARAGE FLOOR ELEVATION
�� = TOP OUNDATION ELEVATION
SCALE : 1" = 3D�
ADDRE55: 14034 BLt�EBIRQ 7RA{L
�OT AREA= 12,004 SQ.FT.
HOUSE AREA= 1,714 SQ.FT.
APPROVED
pLANN1NG DEPT
DRAINAGE AND ��IIl�
(�76.5� U11UTY EASEMENT ��
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1 hereby certify that this is a true and correct representatian of a tract as shown ond described
hereon. As prepared by me this �� doy of S��R , 1992.
, ��.��''-��'�f �' � .��cMinn. F2eg. No. 9086
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