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"EXHIBIT B"
DRIVEWAY PERMIT FOR CITY USE ONLY
PERMIT # ;3- ` — I
DATE / ,
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APPLICANT NAME: � � ��� � ��C � � � � � PHONE: �
OWNER NAME & ADDRE55: � 7`�.� � ��7�c �.�,� �� l � / � I �t/'�7`� � y `� �� �'�
PROPERTY ADDRESS: � �� �I � � �Q- << � /� � � L�. P �—
TO CONSTRUCT: �(New ❑ Replace ❑ Widen
TYPE OF PROPERTY: t�Residential ❑ Commercial ❑ Industrial
Proposed width of temporary or permanent driveway �Please provide sketch on reverse side or on separate
sheet)
Type of Material � 1P/[ �f l�
Is property within the Shoreland District? ❑ Yes �t No (If yes, applicant must submit impervious surface calculation)
The driveway is proposed off what roadway?
Is driveway shared by another property owner? ❑ Yes �(No (If yes, signature of all parties is required)
Estimated Start Date O'� I v� 1 �
Estimated Completion Date 1� ` �� "' � �
SKETCH REQUIREMENTS
1. A driveway sketch is required as 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 the sketch.
2. The driveway sketch should include the 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 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 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 a final inspection.
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"EXHIBIT B"
6. No changes or alterations in entrances may be made at any time without written permission from the Engineering
Department.
7. Permit expires in 90 days after approval date.
8. Additional Conditions
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7. Permit expires 90 days after approval date.
8. Additionai Conditions
IMPORTANT: Before startinq work . . . -
The Applicant shail call Gopher Sta#e 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 ta time of inspection.
As provided in Ordinance Numbers 1107.205 & 1107.206 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 ali work will be done to the satisfaction of the Engineering Department. It is further agreed that no work
in connection with this application shall start until the application is proved and the ermit issued.
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Contractor ApplicanYs Signature
-- Date: •
FOR CITY USE ONLY
AUTHORIZATION OF PERMIT �
Permit Fee $ �• � a #
In consideration of agreement to comply in ali 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.
ENGINEERING OFFICIAL i Date ! `3� ��
Permit is valid if signed by City Official
Permit Expiratior� Date (90 days from approval date) �d " 3�' /.3
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PROPERiY DESCRIPTION DWBl1./
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Lot 4, Block 2,
BOUDIN'S MANOR 4TH ADDITION
Scott County, Minne3ota.
NOTE :
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o Denotes iron monument set, see note •�'OT �S�
• Denotes i ron monumer.t f ound 2�� LONG IRON MpNUMENT AND
IQENTIFICATION DISC fACTUAL SII.E)
SET AT ALL �OIN'IS INAICA7'Ep.
<_9a9. Bz) Denotes S�Ot 21BV��7.UT'1 MINN. REG. LANQ SURVEYQR +7095
[935.5� Denotes proposeci elevation
— — penotes chain link L_nce
`��'. "'� `'•' �' Uenotes concrete slab
,�,-•-- -- Denotes direction of surface drainaye -N � �
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BENCHMAr'i ,Ld30 JNId33NlJN3
SCALE IN FEET
�op o� hyc3rant located near the Q3Apaddd
3outheast corner of this property. o �5 30 60
Elevation = 938.56 Fv.G.V.D.
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White - BuElding �
Canary - Engineering
" Pinlc - Pienning
The Ccnler of 1l�e La4e Cormry
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NAME OF APPLICANT '�' 1 t�.. � •�:,::. . ' '-% t�" r. �t.! �- i 7 �.� ; � r► + �. � �� :! I
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APPLICATION RECENED f _.! '•' �`� �� I
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The Building, Engineering, and Planning Departments have reviewed the building permit ;
application for construction activity which is proposed at: �
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Accepted � Accepted With Corrections .
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De�ied
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Reviewed By: 1
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! "Ti�e issuance or granting af a permit ar approvaV af plans, specificatians and
; compu#ations shail not be construed to be a permit for, or an approval of, any violatian of
' any of the provisions of this code or af any other ordinance of the jurisdiction. Permits
� presuming to give authority to violate or cancel the pravisions af this code or other
� �ordinances of the jurisdictio shaU not be valid." �
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