HomeMy WebLinkAboutDriveway Permit #05-D03 � � DRIVEWAY PERMIT APPLICATION
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� PERMIT # � ����
� � DATE: � �" n
��" ��
� (FOR OFFICE USE ONLY) APR 2 � 20 �J r
TYPE OF PROPERTY�Residential D Commercial � IndusMal B
APPLICANT NAME:
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OWNER NAME: f ����
PROPERTY AODRESS: �/5� ��� r ��/ `P D �'-�G1 ��
MP�+� BY
DRiVE APPROACH I�Q,�
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TO CONSTRUCT: 0 New �teplace O Wden ��
Date: Jf �
wide (TEMPORARY, PERMANENT) Dtiv�e spptosdt �
Type of Materfal �/�'/�-�� �f7�1�� F
G0�'lGf'��� - �l�/�c/�G�J2 l� �D��� ( l� �
RE�UIREMENTS
1. No work under this app�cation is to ba startsd undl appHcadon is approved and the permk is issued.
2. Where work on traveled roadwey is neceasery, troffic must be protected and flegs, signs, safety cones and prop�
barr�cades must be placed In acaordance witl� safety procedures.
3. No breign material such as dirl, gravel, or bituminous materfel sltaA be le(t or �it�ed on the road during the
construction of tlrivewrey. _ _. _. . _ _
4. Road must be swept cJean a�r work is compisted. •
_ _
5. Prior to placement ot concrete or biWminous surfadny, tlte aPP�icaM shall noMY the Engineering Deparbnent tha! the
wwic has been completed and is ready for finsl ir►spection.
6. No d�anges or alterstions in entrances may be made at any time wiltwut �pQi�@n oermission trom the Engineering
DepertmeM or inspector.
IAAPORTAfrT: Befora sta� work . . .
The Applicarrt shell call Goph� Stete One CaN {1-800-252-1168) 48 twuta prbr b staAing work. Applicant rtx�st caN the
ineeri De MneM 952 447-9830 for 24 hours prbr fn time of ine
Whsn widei�ing or oonstrtx�ing rlew d�iveway aPProsc� e�10.00 fee is requir�ed at the time of spplk�tbn �nd a sketch d tlte
P�P�Y �P��B PrsseM and ProPo�ed driveMraYs in relation to lhe property ��.
(Sketch on rever�e side d applicatbn or provide a seve�ate plan)
As provide (n Ordinanoe Numbera 1107.205 & 1107,206� I, We the underaigned, herewith make apP�ic�io�
for permissbn to cor�ahud the driv�eweiy at the above bs;a�tion, aaid drivewey m be cor�abucted to ooniom�
with the standarda of �e City � Prior Lske and to eny apecial Provisiais includad in the pe�mtt. K is agreed
that aq w�ork wi11 be done b U�e sati�sCtlon of the Engineering DepamneM. tuN�er s9reed tfiat no worlc
in oonneation with tt�s applicstion will be started untll the app�catbn is s and 1he Perr►►it issued. „�
, �%�� Z �� � ��� �� , -- Applk;a s Signature
Contrador
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� ��, ������ ASPHALT��& ���CONCRETE BUY KNOX INC. � �
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Detalls Yes No Contact Peraon O(fice Use
� � Cross Street I� D� + S R� ` y � 3/�
ite ress
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Electric Wires ❑ � fty Home Phone 2
Gas ur,e ❑ ( � � 7
Grade Change ❑ ZIP � p ork Phone
Heaving ❑� GR SS 3�a �7s� 732^�q9� CP�?/
Overhead wres ❑ Date ol Phone
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P� w'r� ❑ L,e Lead ource Mep p al� rson �—
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Roof overt�ang ❑ � ��� I
sawcutatstreec��l PERMIT: N� GOPHER: � N�
s�� s ❑ 3 � 1
r►«u� ❑� ��/ ��� DateAppiied: Approval:#
T'� � � Prop.Dist.
T � �� � ---- Existing
w�: s�wt-on ,�1 ❑ AP GR D SW SP P' L FT 7 y
Partial - /L A/C5yr. 1 r:
EXCAVA7E � , f SCHEDULER: PG S/P l
� & . . . � . . . . . . . . . . . .
BASE T ``''� � A.S.A.P. or AFTER:
�� . . . . . . . . . . . . . . . . 10�EA� A-/c
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STEP . . . /////� . . . . .
� REMOVAL . . . . . . . .
�� � � R � �� , SPECIAL INSTRUCTIONS:
— �ucKS • . . . . . .
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BARRIER
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• • � • • • • • • � � coHC��ef P Arrou /8�a rdeYs
�-7( REPLACE � . . . . . �} Nql � f U'H�PY� C� SffCe �
��—� WITH
�� ac , . . . . . . . . . . . . �
ACC.PRT . . . . . . . . . W R'f �I� ' ' �?
�s �r�Q�S . . . . . . . . . C11U7.OFF .
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WHEEL . . . . . . . . . . . . .
BARROW
� . ; . . . . . . . . . . _ _ ------------ -- -
CUSTOM ,. �,---: __. `
WORK. . . . . . . . . -
I
; ,,.�; •, . / CUSTOMER TO ADJUST SUR-
• • � • � • • • ' ' ' ' ROUNDING HEIGHTS TO MAT
FINISHED EDGES AS DE
Regarding this installatan is everyth�g you wanted in writing7 y We have received your hstallation booklel r Customer agrees to pay any required pertnit fees. � Y S ❑ NO
IniGal
�_3�>Z� DO IT RIGST...TSE FIRST TIlViE...BUY HNO%
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