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HomeMy WebLinkAbout4460 Fountain Hills Drive ROW Permit FAC)M (TUE) 10. 19' 04 8:53/ST. 8:50/NO. 4862350500 P 2 , . 4:'rl.�°, 78 / � �' f,� �� SHt'l'D�INSH ��L1��-��,��; ., / I� � � � i `��� ''� , � � « ,,, r,�, ;' � �' = ��� �.�.,,��;�:��.=.L..: �:�;ti...�.�_:���:� ���-��' `�� --���� �� �� �..�-� �.�� . .:¢. � i� ��`/ 1'�;K11iT� \\/ `, ' ti �� TO'�VOI'.K VVIT�IIN C1'1`ti' PRn�PF'RT1'/1•2IC;�t1'-UF��4lAZ'/�:,4SEVlF.NTS ANll r1PPLICATIUN f'(UR [NST:�LI: �TION OF [1TILIT.I�,S 1. L��cation Hol ida y Sta[ iun — 44bU Fo unr_ain IIi ls Or , 2. valure ot��Vorl•: FeP lace existi bur ied telep � _ahi� _ �. lndicate below� items io br 3ffectcd atid inclti�j� a sketcl� ��r plan �f'�vork to he ii�me. _ Curb ��, Gatter 5treet Sutiace __ TraiUSide4valk Trr.FS: I'ond/Wetlands (Fublically owned ^. . Traftir, ��untrul Devir.es/Si�ns or f'rivately oavned __ ) ___ Drain��ge 1ltilities titruch�reBuildui€ Other So�11;crub . ____ �1 �lethod of Installation or Construction Ft�,r�,�� ._ __ _ �. Work tu start on ��r after: � ' 1 i1G __; �ncl sliall be cumpleter.l by: �� _ unless an extcnsion `,ranted to: _ ____ __by� _ _ . —..._ -.-- DAT� STAPl�/L>ATI ; t>. \•Vill detouring ot�traftic 1��� necessary t�;, __.. [F necessary t�i �ietnur tratf�c, describe suggested rolltc: , 7. I-'r�?vidc witf� this appiicati��n a cap�� ot�(ne �onlrar.tors Public L.iabilih� Insurance�. C)P.1 OURS: "!'he C>irector of Fublic bVorhs shall lie natitied in writin� at least 72 hou�,,• in advance of �ny detour bc.ing r.stat�lished chan;;erl nr �isr.�ai+tinued. N ���rr ��r�. �FPLlCANT_��we5t •- - -- -- _ PFfONE_61' - 61-811 1�1,�=.A�F ��fifiV'l' FA.k �12--861-5 i 7�3 1r)nREtiS6"44 Ceclar ��.�enuc 5outh _Fichfiel�l -- •ll�l .- --- --5-�4.'�3 ST'RFi:.T ��'1'1'`i' �;'I"r1TE Z1F' ��1:\f�•IC OF PAR�i Y O}: ��RC�ANIZAI 1C�1�! l'T?RFl:1RR11NCa �V(:�RlL lwest __ .-- ----- �:'�:>4T,�Cl'P�.l:`;(jN: Uan ��i� _..._LMF.It�iF.NC'r'i2�Hf:.jPEIONE �':1-.;p �,1)f?R�:S� �'t �'�.t�.�as�i ��. _S..�_Ciic}l.; ie1�i h1N_.i.�4��)Al' I'NIINEh 'L�61=r3Z_4�- - —.- ti rr�.�:rT �:�rr��� ; �.�r� ��'. l;IlllCfil;'ll:l� ��CI:'�`.'ll�l :I ('ll.' [Ilr i.:_''+'I'i, lll!� ti'fli�!(lil ��1 '�!I• I',.'llill. f". I��:� �'� �� 1 U�;f 1 I , �. t t I.I . ;IF,c' ;i J�I;;C�, , ��t�iin_��.I ^;,,� . t�� '�i:l;, � . • !i�.r .. ll� t �. ,� � - 'i' . - . .... . . . i . . �'r;:�r � ��; "_�'� .` �--- * :r r , � �� � i ... I.i� .'Ul)'� , �� %� �' , „ ' . _ : i � I . I'. � . , � ' . . . I . . . ' . . .. . � . . .. � i . 1 . ' ' � � . . . '. ; . . i . i l . I _ � � i . • -� EXHIBIT "C" TO PRIOR LAKE PUBLIC WORKS DESIGN MANUAL PERMIT TO WORK WITHIN CITY PROPERTY RIGHT-OF-WAY/EASEMENTS AND APPLICATION FOR INSTALLATION OF UTILlTIES PAGE 2 t FOR CITY USE ONLY , AUTHORIZATION OF PERMIT , ,� FINANCIAL SECURITY: AMOUNT: � TYPE: � � : (Cash, Bond, � LOC, Etc.) • ' Fee: $ i�.Q' No. Permit No. �A-6�f - �y LIABIILITY INSURANCE PROVIDED: // /ptS�t U�/�"'� tiL _ 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, said work to be done in accordance with special provisions as hereby stated: 1'lj�Se .�lt,�o( D4 ✓viu«/� ('t� �� SD- �� APPROVED BY: DEPT. OF PUBLIC WORKS ... B i7� lQ' �y��/ /DATE r ALL LEGAL REQUIREMENTS SHOWN ON RAGE ONE (1) AND ON ALL "SPECIAL PROVISIONS" SHALL 8E COMPLIED VVITH. THE DATE WHEN WORK IS COMPLETED MUST BE REPORTED TO THE ClTY OF PRIOR LAKE CITY ENGINEER. ' , � } , � , . G: Wdmin�FORMS�LTXE�BIT C APPLIC FOR INSTALL OF UTILITI6S.doc � . . � FRt>M (TU�O. 19' 04 9:07/ST. 9:07/NO. 4862350502 F 2 - ` . � �. � .- � � t l� �' �i r�f� j' �; � �� ., . � � ��ti �i „�i � -��; K t �r: r�c�� 4� I ' ' i ' � .� 4 ' I a . . 7��%j2��U".�� �'' c' }� s'iJ , F.. , nde Ihe lighl , - �. ..:.� � ! _ T - ` � -� A, Y �1e. � w e t ;� � 7� � , � �- —. �. . .�. _ � :� . _ f�' 2 WORK LOCATIOP,: . t ,� �uUN rA-r�v /�;e.-�` r)„� � �� � � -�: o ;'� � r�l k E G-hik ��7 � f,. � ::� � � ;.. � � �_ � ;� e�o �y7� � n �s ; � �✓t<< ( "� � � �R�9�� 7`v rtri�-I o� y �.•. _ - .._-.--., . -r ...... � ��"TI t�� �� � �.0 �'h�v,l)Ti c•: '' �E G✓ ,�t taoN ��,�y' C�.yy-r F�, � �j~ , � oR � . �,0� � �..�� i ��� DRAWING DISCLAIMER _ s 5.! ,�;� , � "_ �- � � _..------ - — �. �.. • FACITILY LOCATIONS ARE GENERAL � � �- - - � l � — � f � - s � IN NATURE Qwest WILL NOT gE HELD cd:NB 5 � � —'' �� / .._ . ACCOUNTABLE FOR THE ACCURACY � "' - s �� "� -�-��-s OF TME INFORMATION PROVIDED ON ; _` -.... _._-.-.,,.,....�.,..... _- •�_.,.. . � � 4.1 �' !� C °�41�rR THESE DRAWINGS . _.,_ .v'h�'i�t'a� �.._ ..._ �-_ _ , F�� �fli(�/fl�+' - -�j � !-�-. _.(�.. � i� � s'�.� � yt3-s'�-p � J Restore all disturbed surfaces to a � i original or better condition GOPHER STATE ONE CALL � 1 800 252-1166 s� + , Uwest Engineer: GARRY `�pH�1 � 6244 Cedar Av S " Richfield, MN 55423 � � Teleph�ne Numbe� 612-861-� � 'i ? � � Fax Number 612-861-8�173 � . "l ���i � � ��� -L7- � �`— T����.;, _ ?;��&� =��e � ` , . � � � 5 t. ��'� � . � � , , �.-�<•�: :J;p _ -'^" • �. '.... i i .. �.i �, . � � ---�. I I � � i i � , ir e...-v.. ^ ,. � .. � .. �.. .. � � ° _.... < . _ � � _ � � / � . . . � . . . ^� � �. .. � � _-''� . � : ' '.. � s-_1 `� . . � ' �..��.� ^ v . 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