HomeMy WebLinkAboutDriveway Permit 15-D-24 � DRIVEWAY PERMIT FOR CIN USE ONLY
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��r` ��df�;����; Email completed form to NBriese@CityofPriorLake.com DATE � �""���'� �
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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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APPLICANT NAME: dorn constructi0n
OWNER NAME: eag�e CI"@@I( VIIIaS
PROPERTY ADDRESS: 4345 prior�w0od St Se
PHONE NUMBER: 612-386-7850 EMAIL ADDRESS: dornconstruction@live.com
PROPERTY CLASSIFICATION Single Family Home DRIVEWAY MATERIAL: Concrete �
Proposed width of temporary or permanent driveway 16�
(Please provide sketch on reverse side or on separate sheet)
Is property located within the Shoreland District? NO �
If yes, applicant must submit impervious surface calculation
The driveway is proposed off what roadway? priorwood st se
Is driveway shared by another property owner? (If yes, signature of all parties is required) NO � I
Estimated Start Date: �/� O/� G Estimated Completion Date:�/� �/� �
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SKETCH REQUIREMENTS
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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
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separate sheet. The sketch does not need to be drawn to scale, however dimensions must be provided on the
sketch.
2. Driveway sketch should include the proposed driveway,existing driveway(dashed 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 raotify the Engineering Department at
952-447-9830 that the work has been completed and is ready for final inspection.
6. Permit expires 90 days after approval date. �
7. Additiollal COndltlOnS drivewey being replaced same size as existing �
driveway being replaced same size as existing
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� �'i��c,�, DRIVEWAY PERMIT
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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 work in connection with this application shall start until the application is approved and the permit
issued.
/s/ /s/
Contractor's Signature Applicant's Signature
FOR CITY USE ONLY
AUTHORIZATION OF PERMIT
Permit Fee $ 'w��° �� �
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 and submitted drawings, said
work to be done in accordance with this application and submitted drawings.
ENGINEERING OFFICIAL � �� � � ������������� Date �� � �
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it is va i if signed�±�:yi � � � ��
Perm b City Official
PERMIT EXPIRATION DATE(90 days from approval date)
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