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HomeMy WebLinkAboutIndustrial Lane ROW Permit �� � � SOB �Oln-O[o4P I� E ��1� `�'' � APR 2 1 20i;o L PERMIT B�r TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILITIES 1. Location INDUSTR1Al. LN, p D'E.�.(Z.�IEL� INDl1STRlAL P�tRK." 2. Nature of Work �.��E� OF COPPER P}{OWE G4Bl.ES AP.1� PLASTIC CONDU IT' It�1 SO11JT TR�NCk! W 1TN MV�.C.. POW'E.f` AND 4A5. �. in�icate below items to be affec�ed and ir.clude a sket�h cr nlan of work to be done. Curb & Gutter Street Surface TraiUSidewalk ' ' ' � Trees: Pond/Wetlands (Publically owned Traffic Control Devices/Signs or Privately owned � Drainage Utilities StructureBuildings Other X BLVD . ` 4. Method of Installation or Construction .B�C,kI-tOE. -SDINT 'CR�'JJGN " 5. Work to start on or after: 5 S� b(o and shall be completed by: � D�'y unless an extension granted to: by: . . , DATE � . STAFF/DATE 6. Will detouring of traffic be necessary? n1� If necessary to detour traffic, describe suggested route: 7. Provide with this application a copy of the contractors Public Liability Insurance. DETOURS: The Director of Public Works shall be notified in writing at least 72 hours in advance of any detour being estabiished, changed or discontinued. NAME OF APPLICANT = N����-� T�-�- ��-� ��-- PHONE RS Z-`��'375E?a PLEASE PRINT FAX 952- 2Z(o - 375a ADDRESS `�`� ���R st. 5�� � Pl�►AR. LA1Z� M N 5 S3� Z - A Z.°15 STREET CITY STATE ZIP NAME OF PARTY OR ORGANIZATION PERFORMING WORK CONTACT PERSON: �N aA��v�- EMERGENCY (24 HR.) PHONE #: �� 2 9� g ' S 8 S � ADDRESS DAY PHONE q52-22Lo -'7flfi.+4- STREET CITY STATE ZIP - The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein con ' ed ee to fully comply therewith to the satisfaction of the City of Prior Lake. Signe . Title: �� 81 N�` E� Date: 9 ' ' 2 �"' 0 �O 79 .- , �XHIBIT "C" , ' FOR CITY USE ONLY AUTHORIZATION DI' PERMIT FINANCIAL SECURITY: AMOUNT: TYPE: (Cash, bond, LOC etc.) Fee: $ �t�b�e Receipt No. �_ ?�rmit No. —�jr•�� LIABILITY INSURANCE PROVIDED: Qr'�+r�� I����G �v� In consideration of agreement to compiy in ali respects with the regulations of the City of Prior Lake covering such operations, and pursuant to luthorization duly given by said City of Prior Lake; permission is hereby granted for the work to be done as described in tlie above lpplication, said work to be done in accordance with special provisions as hereby stated: . , APPROVED BY: DEPT. OC PUIILIC W02KS , By: s /-06 ' lDATE ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (I) AND ON ALL "SPEC[AL PROVISIONS" SHALL BE COMPLIED WITH. THE DATE WHEN WOIZK IS COMPLETED MUST BE REPORTED TO THE CITY OF PRIOR LAK� C?TY ENGiNEER. 80 o a . �� �� / �� d � � �' � � � � y � � ��' � m � y � Z Z ly � o d a Z� W � \ � ' � ~• � G � z V , °� ��`� � � I � ti, Q A . 9g, �C � � � � � � c , � -� � � � � �. m � �', , � z m b � � o� � � � O� d N 4 J I � d � m � � `-'-' � /� �I z � ��' � � �� ;' / D -+ �� '�s �� � �� �,�, �� � � � 3 � � �v I �� m � q< `� � � r ' — ,ti S� � `� , �,� � � � � � �. � � �� �� � -� �� - � .� � � ��-. �� �' . '� F--i H k--1 H D V'\ nnnn � z \ t� -P W (U '_' d �' � D Z -� � -�� • � � � — �j m fU .. I � ' H { � '-� � �T � � v � � � � -� o � � � � '�v �, � � — -� � � o v *k (� � 0 r n � ° ~, N VI � � � � � �-+ N � � � � d � Q � � � � I c , -- � � � I� r n rv "'O � �n � � `_" • � � �� , � __� y � � � � �� �� � � � � � , , . . �.,:,�.: ���s:�,s.�,: w., ,..�:,nx,a;, , �, , — ,� . �,t� .r. �� �. ! 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