HomeMy WebLinkAboutDriveway Permit DRIVEWAY PERMIT FOR CITY USE oN�Y
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�� ��'� Email completed form to NBriese@CityofPriorLake.com DATE
t��� �� Mail$30.00 check payable to City of Prior Lake to Nate Briese CHECK# `
� �� � 4646 Dakota St,Prior Lake MN 55372 RECEIPT# �� � ��� �
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APPUCANT NAME: �,,,"��,, b � � '
OWNER NAME: ���"� •� ��� ��
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PROPERTY ADDRESS: � c�. �' � -� x� ` ��� �,,,�
PHONE NUMBER: W � " �'.. - " ��� EMAIL ADDRESS:
PROPERTY CLASSIFICATION Single Family Home DRIVEWAY MATERIA�: ��}t �',,������,
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Proposed width of temporary or permanent driveway
(Please provide sketch on reverse side or on separate sheet)
Is property located within the Shoreland District? �
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If yes,applicant must submit impervious surface calculation
The driveway is proposed off what raadway? ,�° �� ,�, �,� "�.
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Is driveway shared by another property owner? (If yes,signature of all parties is required)
Estimated Start Date: � � � �- Estimated Completio�Date:
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SKETCH REQUIREMENTS
1. A driveway sketch is required as part of this permit. The sketch can be drawn on page two of the permit or on a
separate sheet. The sketch does not need to be drawn to scale, however dimensions must be provided on the
sl<etch,
2. Driveway sketch should include the proposed driveway, existing driveway(d!ashed line), driveway dimensions, ,
property lines, dimensions of driveway from property lines, building locations near driveway, arrow indicating
north,surface features near proposed driveway location (trees, hydrants, utilities, etc.)
3. If on a corner lot,the sketch should include dimensions to intersecting roadways.
CONDITIONS OF APPROVAL
1. No work under this application is to be started until application is approved and the permit is issued. �
2. Where work on traveled roadway is necessary,traffic must be protected and flags,signs,safety cones and
proper barricades must be placed in accordance with safety procedures.
3. No foreign material such as dirt,gravel,or bituminous material shall be left or deposited on the road during the
construction of driveway.
4. Road must be swept clean after work is completed.
5. Prior to placement of concrete or bituminous surfacing,the applicant shall notify the Engineering Department at
952-447-9830 that the work has been completed and is ready for final inspection. f
6. Permit expires 90 days after approval date. 1 �/� '
7. Additional Conditions '�rt�Se lUc��r �vf��►�i�eS ��- ��w�. ������'� i�� i�c� �
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As provided in Ordinance Numbers 1107.205 & 1107.206, I/We the undersigned, herewith make
application for permission to construct the driveway at the above location, said driveway to be constructed
to conform with the standards of the City of Prior Lake and to any special provisions included in the permit.
It is agreed that all work will be done to the satisfaction of the Engineering Department. It is further agreed
that no wo k'
' �h this application shall start until the application is approved and the permit
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issued
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Contractor's Signature Applicant's Signature
FOR CITY USE ONLY '
AUTHORIZATION OF PERMIT
Permit Fee $ `����'�
In consideration of agreement to comply in all respects with the regulations of the City of Prior�ake
covering such operations, and pursuant to authorization duly given by said City of Prior�ake, permission is
hereby granted for the work to be done as described in the above application and submitted drawings,said
work to be done in accordance with this applic ion and submitted drawings.
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ENGINEERING OFFICIAL �`,�^� m�'��-� ° �'"` �'m� Date �'� � � ���
Permit is v lid if signed by City Official
PERMIT EXPIRATION DATE(90 days from approva)date) �� �"� �'j.�
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# �'��� �� �� "��`�"��'� � ����"�����'� No Yes ❑ Ok to use Bobcat
# Replace as is �°' ❑ in yard. Customer
Flares �w ❑ repsonsible for any
Stumps/Roots ❑ ,� yardllandscaping repair.
Water shut off �<�'- ❑
Premium Goncrete �erv'ces � New Cover �' ❑
❑ Apron ❑ Patio p'°bnveway �J�;�����ad'� Drainage Problem � �� Initial
❑ Sidewalk ❑ Steps ❑ Garage Floor � aesign on separate capy ❑ Garage �7oor 7' ❑ Sprinkfer heads?
O Staop ❑Curb ❑ Other
❑ Footings ❑ Other
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�'Permit(if needed) - ��.o�'�.��.,��,�"��wra�� ���a•�m,. �� ��- �q,�,�,��_,
❑ Remove Asphalt(E�ra charge if over 4") �,� ,��� ��y� � �
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�`'Remove Concrete (Extra charge if over 4") �����
�'"�Remove Gravel, Dirt o��oc�i���m�
�'°"�Addition to driveway �������
�'Basework as neetled up to 4°
�" Regrade for proper drainage �
��318" Rebar 3'on center � �� ����
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I�'� �"��"� Signature Goncrete Mix ' y
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�"4500 PSI �.r�r� k '
Cl�Micro Fiber. ��"�� m�.. . . �,. - , �m, ���"� �I
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e�' Saw Cut 1 Hand Tool joints I Zip Strip (8 feet or less) ��� � ��� fi
��7"r�ure`Agent/Sealer�� � ' �- '� r
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❑ Backfiill: Homeowner � � �� �, ,, �� � d',�� 1
❑ Grass Repair�Homeowne �,��,��-��, � "���� �� �� � �-�� b
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Estimated Cost: �°"' � �� ,
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Cus erApproval D e .° -- - ,—_ � ,w. �_ :
I have reatl a d ee with the terms�and conditions on the reverse side �
Praperty Line? �
SIGN AND RETURN WHITE COPY �
❑ Compd ❑ Subpd
7745 2nd Avenue S � Richfieltl, MN 55423 ^ Ph: 612-866-8073 ^ Fax: 612-866-8078 •www.richfieldconcrete.com
Licensed • Bonded • Insured �
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,;:,:�� �?��r��,.�, City of Prior lake RECEIPT
��� �� ��.. ,� 4646 Dakota Street SE
��;" �'` � Prior Lal<e MN 55372
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��" '�,= 952-447-9840
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Receipt: 2371
Received Of: Date: 07/28/15
Richfield Blacktop customer: Richfield Blacktop
7745 2nd Ave S
Minneapolis MN 55423
Receipt item Receipt Description GL Number Total
Driveway Permit 15-D-17/4364 Chestnut Lane
Zoning&Subdivision Fees 30.00
Receipt Total 30.00
TENDERED: Checks 7620 30.00 '
Total:30.00