HomeMy WebLinkAboutDriveway Permit #13-D-03 T
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FOR CITY USE ONLY
DRIVEWAY PERMIT PERnniT # 13- D-03
DATE (�-/2�
APPLICANT NAME: �P�IJ ( .C71V ��� UG� � 0�..� " ��' ' 3 v� • �[/ �O
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OWNER NAME: GC[OIG C/ U��1 QS
PROPERTY ADDR� yy�9 � yyl3 �IY�y yy16 yyo8' 3SfS y3�Fs
P�i Ot` f,�bd Sf SF Pt`i o r (,C��e
TO CONSTRUCT: ❑ New �2eplace ❑ Widen
TYPE OF PROPERTY: �Residential ❑ Commercial ❑ Industrial
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Proposed width of temporary or permanent driveway C7 (Please provide sketch on reverse side or on separate sheet)
Type of Material CONLPe.f'�
Is property within the Shoreland District ?❑ Yes �No (If yes, ap licant must submit impervious surface calculation)
The driveway is proposed off what roadway? P c i a c w �o � � S�
Is driveway shared by another property owner? ❑ Yes � o(If yes, signature of all parties is required)
Estimated Start Date �
Estimated Completion Date U Z �
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 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;�,,
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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 aermission from the Engineering
Department.
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7. Permit expires 90 days after approval date.
8. Additional Conditions
IMPORTANT: Before startina 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 construct the driveway at the above location, said driveway to be construct to conform
with the standards of the City of Prior Lake and to any special provisions included i the pe . It is agreed
that all work will be done to the satisfaction of the Engineering Department. It ' r ed that no work
in connection with this application shall start until the application is approved d pe issued.
� or� �v5frt�tor� �1-� L
Contractor pplicant's Signature
Date:
FOR CITY USE ONLY
AUTHORIZATION OF PERMIT
Permit Fee $ � �0� ��
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.
ENGINEERING OFFICIAL Date �i r �'Z + ��
Permit is valid if signed by City Official
Permit Expiration Date (90 days from approval date) /'� z' l.3
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