HomeMy WebLinkAboutTower St ROW Permit ._
j
i
I EXHIBIT "C"
PERMIT
TO WORK WITHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
AND
APPLICATION FOR INSTALLATION OF UTILITIES
1. Location TDLU�E R S T. � 9 ' "��� �
2. Nature of Work � FNT �F CABLt RND DU LT F�R xlEw F�S� �FFIC.�
3. indicate below items to be affected and include a �ketch ar plan of work to be doifie:°
. � ,
,. � ,
Curb & Gutter Street Surface
� ' �'rail�Sidewalk , . . , .. Trees:
Pond/Wetlands (Publically owned
Traffic Control Devices/Signs or Privately owned _)
Drainage Utilities
StructureBuildings Other U T.rL STY �,95�/rl �N T
4. Method of Installation or Construction �� '�'R FNC 11 . " �
5. Work to start on or after: �l-�3 dy and shall be completed by: � LUEF�C unless an extension
granted to: by:
DATE STAFF/DATE
s . » . . . .-
6. Will detouring of tra�c be necessary? JUD 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 established, changed or discontinued.
NAME OF APPLICANT S�TFrfrRA TELE LdA1 PHONE 13Z y`�7--37-58
PLEASE PRINT FAX 9S Z Z 26- 37SB
ADDRESS y690 CDL�JRi�00 ST S. E. !'RT.Dl2 2A/L� lI1N �537Z -DZ 99
STREET CITY STATE ZIP
NAME OF RARTY OR ORGANIZATION PERFORMING WORK ����� d' NlGHS�'Rd!!l
CONTACT PERSON: DD/l� BAR 2AGE� EMERGENCY (24 HR) PHONE #: �� Z 9/9 � SBf37
ADDRESS SA/I'lf AS f��/JE DAY PHONE 9'SZ Z26 7D6y
STREET CITY STATE ZIP -
The undersigned herewith accepts the terms and conditions of this permit by the City of Prior Lake as herein
contained and agree to fully comply therewith to the satisfaction of the City of Prior Lake.
Signed: �4�� T��+"�'"Z'itle: D.SP �Ncrl/!/�E�2 Date: .3 ZZ
79
r
EXHIBIT "C"
FOR CITY USE bNLY AUTHORIZATION OF PERMIT ..
� FINANCIAL S�CURITY:. . � . AMOUNT: TYPE:
(Cash, bond, LOC etc.)
Fee: $��. �� Receipt No. d�2 Permit No. �" D�' �/
LIABILITY INSURANCE PROVIDED: �/��/QV� �'lrD�� �To� iNsv��lcE
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 de�cribed in,the above application, said work to be done in accordance with special provisions as
hereby stated:
r . .
" APPROVED BY: DEPT. OF PUBLIC WORKS
s • -6-0�{
/DATE
ALL LEGAL REQUIREMENTS SHOWN ON PAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL
BE COMPLIED WITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE CITY
OF PRIOR LAKE CITY ENGINEER. •
80
�� R� - ��,> - ( "' � c
� ? � MONROE '� — z ` � � �
* ���n i � � n nvE � S � .��\ � '� � � �. ` '�
r m a »
0
` '�� . . PEW EFVE � � � � 8 NE H 5 W p � OUC,*
• � ,d 3 UNW9EAVE �_�' � „p L Q p
�.. a
�� �` ,\-� - � 9VCAMORETRL :�. . �� Q �'� �j, 6 M y
O � � � �� 8
�' � < L O W B .� . , 0 6&�.
� , m •, Q�, � 6 �ar+ess
r � : BR85 � ,`, . . : � � `�b W
4 � (" 't9 E83N09E
�S � BANT Mf1�DOW � 2 � D .� T
� � n p - ` � � a �
�y A VJ�� ' � r
� � i )
� P WOU '�� . .� �71 0 . . �. A � � .
V6 BE.� . . a . L F � ' . .
� _ .. . ' ..�. . 0 � .
M ,` � LO N � � � �Ci
PI�l� �
�:. W�BTg �C �
� � �, m P � .
aD � � `� � '3' ``' �
� r � p� m +�' � •
P
r� � g � � P� . kY I N E a
. �..'.'".".""' ""�- ...' "'... .,"""..: � � � " �..�....�. ""'..�.. .OUT -.. _ . . q... . """."" "'" .�� _ � � !C y 4� ..
� . v; � � E., .
(� � tp y d
��. ' FIVE WAa�N w tl '�. � � �O
A 1 '� � !�
. � �� O � gg Tp� �
� .. y � `""........:-._. ... ....,., . �
J:� FI ry �.:. � � ��
T H C `
m
M14MAAVE EKSIOECIR � �
w �`� AVE W AVE � �� � ' F
L� q
� Q ; +�'w'�� o � g MVy N N, � 1 �
�. ONO � 'a � F
b ., �
� �vt �, F � � � � enaa
� N.� ..a °"�+ � f
'r �
���+ ., WIUfHAVE ... �
aT � ' a � `� A N `O •.,�.
� � � � ea,,. � � :
'a *+G � � $ , -�
�:� �.�K-: �' � � ' y ., lt �� �� .
PoIX3E4V000 E'NCT p � . . . .. . .
W CIR
S �
� N9WIp(A � .
�? � ND9 vKW� � � ��F
l �'({�.� �� � '6 0�� F F � O �-�;`
a . � � �f. m � ev �t
vi : >°x �
.,
s CJ1 Z �:. �: � e ~ � y � N � . ' ' �'•
n O E a
r ��g -� y � �..i � � . .. �� p _.... � . .�..� . . �� �.:.. . � . .
_. . ..:.:�.,,F�_ . :-. ,.- . . . � ` .' ... ;.:,... {�
��
OQ E �N ., .. y A L ' PoOOEMWTA�/E x = yf �.
; � N y� � E � � � H , y � o . .
� � b o
, �, ¢ ►y O m
:�: v��� . �i�� p c�l Is = � ��. . �
� '° '�� O `" � � M
f o� Z � � � . me�� � �, F �. �� � . W ro . .
�
f. p
{' ' w FRFl141 litL .
R'. 9 � �n �' Y� � � � m � .
- i- m � } ��� � (� pA D` . .
� N
"e' f M � y ��N d`�T ,�� � IT FVE Q
r �
n
.t� ° � � � � o e
�: � �,
C . E n � � < . FL
o y y � `� 4 m yN �o
t. A � � {n g
� � d m m M�� �'i' � Fi o � A�N � T ,,p~ .
'� N � 9 �I ���b � � 1 1 � � � � Ip . .
� �
A � H Pl a � � . � V .
i � � ' � - . � � y O
< . ° a m
�� ✓'�.r . . ° W^ � `� O ° � `3
-- i s"� �- `:. � O ° a,�A' � �n� q � '. � �
� i: o 1�.. � F WN
f. C� P . > F I S M R �!S TRL
� ' y " � ri Z Q .
, y �� Q
i � c A � x ,�. '
x 7C � � �'
n •.� k� �� WltODM nVF m . s m o y O p 0
:th ¢
Q
] � � � C A
{' + F �
�t " � �
,i,�. x m . �� 30�
?N... � . _ ., d,.F�,,: �,. .... . . :..�:. . :�:
. �.....,., .:�:: '_. ,,.r.�e,�i, . �.e n... ...:..�..._e. v..�.:_ �...�v....'..:, :o .'.8< ..r:�r` ,Y9 '::Fy . F, h .
V � RNNBONRMM � � �. . . B�R�E E �
N � �A T
V�
m
a� m ��`3�����mj����'�'������O�i���om� ��Ar4i��� �
� . }� rnnnrrrrr m2 0 y 0� v�� �'��� �� 00
./� � JC� ' ��N i�i
R �T RA� l AA e r � �O��xS 9
-( mm D vM1SA����Fy=jyyyvmj{���o$jvD��DfnoAy s�omA.o m
� p y� . D�Z; � y T s.79
mm �c aD7� : �m3? ���g� �A7��D�A 7cqmpi
�� {n ��E . m ` ���ommmv�sc' �` 7��E 7� nE mE a
7C: : N NND: Ni ; i.b
..:�... �. : ��. 9 4lN�: �. ' ; �'�'9�
�� ... ;Sii :L�?�:iL'•i. ..;R:':..`�`$:
��
� MINNESO7A BLUEPRINT 613728
r �
W N Z �
O 3
� z -= a m y '` T �Jr�-
. v
��,��.
G
n
o m
� 3
I.� 3
�1 ; � �
� m � m v e � 1 ^� i
� ;
y T
h ,�� ti;N
;Q N Z
� ; �4 M � � �
� N 4 � o M
� o �?� � �-'�>"
� !A � O � � o
r �� � o� w <
, � � � \ �' ° `' �^
�� ti� � ��
�1 m r�; .�
n o `'� � N I° �
0 � �� � o a
�0 � �
O °
� N m a
a � �'
a � �� w � o�
. �
y � �� '� � �=
� � n , ;-
o a:
� •�
s.
:�
� `, T ~s°
u
'1 �
J N�
n Q
� � � �
� A 4 m
x
� �
x
� �� '_
..� �
� � � n
w °
�
z�
'� " o
_�
4 m m
A m r-
� b�� m � �T,
� T o
n \ � o R+
I � \`�` D �
11 ' p i . � Cy� i Z
v j 1� fi �. -�1
� Ot\-C m
�p � �
y
C
m
�
; = g a n� �
� �
a -�
� ` ^
2 w� � „C
O O O C
1 H � �
m � 7s- n
y i
�� FIUE O
� '::�/�:::7r,, �•.; `r,
` � ``'
�
�
�