HomeMy WebLinkAboutDemolition 13-902 I CI 1:1 0 DDDO T 0 > 20
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CI O P QR LA' .:•• - - • IT, Date Recd
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
" AND UTILITY CONNECTION PERMIT - / `"
t r O /3 96 2_ . rink � MIT NO.
3 vino hi e.
� � PERMIT
(Picric or = , int and ` :a at bottom)
ADDRESS ZONING (office use)
io- L, ,.a . (ut 5 -- 6 --- '7 - ..
LEGAL DESCRIPTION (oktre use only) t
LOT BLOCK ADDITION PIL) ZJ, 935 DO r .0
owNER -
(Natxxe.) _ (- - r ' " Y . 1'4` .._..._ 6 r � . __ ; - . . . ... (Phone) e l5 r w- 4 7 -- r 5 6 ,
fAciclt stay 6 Oa e ..) , P1 L 55
(Colupany Naxne) Incad' el- _ —1- '; ' ; n5 G- ?( C ex c9., 4, it (Phone) 45 d e7&-- ' 3 ..
(Contact Name) l ',
-� + (Phone) el5, - 7 : 3 -( I 5
(Adtheaa) i N*± ' _ -? . a5 . t beue }�IaJt e. t v,p 5 6c f
TYPE OF 'WORK ij New C ansintction Oiled CIPorch ate- Roofing f Re Siding °Lower Level Finish 0 Fireplace
C Additiulu OAtletatiou OUtility C ennection
Hype of Construction; 1 II III IV V A B
Occupancy Group; A B E F III MR S U PROJECT COST /VALUE '$ 1/ Z 0 C
Divbig 1 2 3 4 5 (excluding land)
i Well mat' that 1 knee hatted utformatlon on thus application which is to the best of my knowledge true and correct I also certify that lam the owner or authorized agent for the
above-Mentioned prop etly and that all coasuwctioa will conform to alt existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building
official an, v)ie this ■ ,t t • ' _. cause, 1 utthermore, I hereby agree that the city official or a designee may enter upon the property to pa= needed inspections.
xr 'i$ttaturr Coutr or's License No. Pate
Pertiui ` 1llatiQn Park Support Fee
Permit Fie $
Gow& Mad IMu■ItIIIIiIIrlIllli— ZIIIIIII
•
State li Iva ( �'�i�' a` ./ P ressure * �.
- r / ott v.) Reducer MIL` 0
Penalty $ Sewer /Water Connection
PluMling PerlttttFre $ 'Water Tower Fee
IIIMINIAlla PEIL Ik
echad cal Perxtut ee S _ .' Builder's Deposit
'ewer "Water'ertnit Fee $ Other IINP2allIlIlIllMIIIIIII
Gas k'irrelaee Permit .1.;ee S TOTAL DUE 1111111��
'11tis A cats. *cows Your &tabus l'ctxuit W , ., ,, , ed ' ■ - ■ � — j�4S•91 . mss_ _
i
g r - 13. *ate ✓0 D /T / DEPosI j"
kEQlJ/ R.ED
Tins is le ccttJt)' that the tegtlest u the above application anti accompanying documents is in act... with "' Zoning Ordinance an may proceed as ested. This document
when stsued b) the City Flamm cottstnutas a wirmonny Cartth ate or zooms cotnplwnce and allows construction to c ttalut, .SrJ' ncy, a ' ate of Occupancy must be
t•sur,
twine Da'ecto: Date Special Conditions, if any
24 boar notice tar all ipipecti oas (452) 4474850, fax (952) 4424245
4646 Dakota Street'S,E., Prior Lake, Minnesota 55372
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Site Restoration Prapo al For Demolition
tion
Applicant: 77 L//V c AP AJL 631e4 V4 77 /k/07
Address: /' 00 C ! fry/,V fi &A/Lig .5". g.
Cheek boxes below:
X' Fill Excavation to grade
Sod or seed all bare soils -
>C( Erosion control (see handout). Maintain erosion control until turf is established.
; . - -. - .
a
. ■ i
• . Li i:1 • 1 Ai Ilf iNa. 1l il'■ 1 •• 4W -; _-•.- -•
enmval.
'. -_. * 'E .. a -._
. .10 Disconnect elec at meter. (By electric company}
a _
. . _ . . w. . -- y • ■ - t A I - r vip
.., ay ••' - 4 II i .i .• . 1 "-
X Remove existing structure foundation and footings, materials, and debris.**
Provide dust control by following means:
I. Water mist from a water supply (i.e. neighbors, water tank)
- 2. Enclosure
3. Other
4* - I LAKE •
Comments: (provide survey or draw sitepANFOrolt 1 iligi&i2:-._. 1
MOM PERMIT NO7
PT l' • SUBMITTED
EPTED WITH CORRECTIONS AS NOTED
0
Thew comments are NOT ACCEPTED - CORRECT & RESUBMIT
In Ibill compliance with *1 applicable icable building ild. wo n c dom
8non inpcoded.
*Capping of utilities must be inspected.
elapdmittenb including Name not
KEEP PLAN S ET ON � T retina
Final inspection and approval of restored site required. Deposit will be returned after
approved final inspection.
, ' ' -
Si:, ature Date
7:\1 TJI DINO\HANDOTJTSTemolition Restoration.doc
•
\3-e(to
r,w H H E s o t a Minnesota Department of Health SEALING NOTICE VERIFICATION
Well Management Section
m[DH P.O. Box 64975
This is to verify that this office received a notification on 8/15/2013 that a well
St. Paul, Minnesota 55164 -0975 (Minnesota Unique Well No. 0000193342) is to be sealed by
DEPARttdEN7orNFAITH (651) 201 -4600 or 1 -800- 383 -9808 BOHN WELL DRILLING CO., INC. at:
Well or Boring Location Address: 16000 MAIN AVENUE SE PRIOR LAKE 55372
Location: Township Nahe' LAKE No. 115 Range 22 W Section 35 SW SE SE
This well must be sealed in accordance with the Minnesota Rules on Wells and Borings.
MDH staff may be on site to inspect the well sealing.
PRIOR LAKE, CITY OF
17073 ADELMAN STREET
PRIOR LAKE, MN 55372