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Home My WebLink AboutDriveway Permit 16-D-19 A *Single Family, Multi Family, Commercial , Industrial , Agricultural DRIVEWAY PERMIT FOR CITY USE ONLY o Nur, "Exhibit B" PERMIT# /6 — t_... /C) 1 760 ' Email completed form to NBriese@CityofPriorLake.com DATE 7, Z S '' 1�I ' " Mail$30.00 check payable to City of Prior Lake to Nate Briese CHECK# 3 C/ 4646 Dakota St,Prior Lake MN 55372 RECEIPT# 49I APPLICANT NAME: CIA (A)jS� OWNER NAME: 1Lyc Lyes-' PROPERTY ADDRESS: 1 119-lei W I I I nJ tivu S PHONE NUMBER: GIS--- t{ 111-2A2EMAIL ADDRESS: a/l SSrti r, bjk_tr 1,04mPSA, Cm- PROPERTY CLASSIFICATION Single Family Home * DRIV ATERIAL: Asphalt** Concrete) Paver, Other Proposed width of temporary or permanent driveway (Please provide sketch on reverse side or on separate sheet) See 1004 , Is property located within the Shoreland District? -Y No If yes, applicant must submit impervious surface calculation The driveway is proposed off what roadway? Mutt)) ,eS}alot( Sh,d 04 kA)i o-u-) Lairy SW Is driveway shared by another property owner? (If yes,signature of all parties is required) —Yes-- b Estimated Start Date: , Estimated Completion Date: 1 7/4q/ca 74.///4, 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 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 notify 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. Additional Conditions DRIVEWAY PERMIT "Exhibit B" EXCAVATOR AN L1, OPERATOR'S CDR'S NO I`l E This notice is to inform excavators and operators they must comply wi. Sections 216D.03 to 216D.07 of MINNESOTA STATUTES 8/ Call Gopher State One ht'R " Call(800)252-1166 or 651-454-0002 Or go to www.gopherstateonetallorg Smart Phone: http://mntidcetentry.korterraweb.corn 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$ 30,-0 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 7-2 c-/,‘ Permit is valid if signed by City Official PERMIT EXPIRATION DATE(90 days from approval date) 41)/e.) Z.S -/ff/ di m'04. DRIVEWAY PERMIT Ft [ '�• "Exhibit B" \ --111111 , _...____ _..-.. , IMPORTANT— BEFORE `i R i G WORK EXCAVATOR AND OPERATOR'S NOTICE This notice is to inform excavators and operators they must comply para, Sections 216D.03 to 216D.07 of MINNESOTA STATUTES S ilt :h1f4G Call Gopher State One , ::.::: • .);/; Call(800)2524166 or 651-454-0002 - Or go to www.gopherstateonecall.org Smart Phone: http://mnticketentrv.korterraweb.com 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 ,Ap ;WY nt's S'l.•; i ) pi (& FOR CITY USE ONLY AUTHORIZATION OF PERMIT Permit Fee$ .3oz 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 d1,0 _ �7 Date ! —Z.S _'�,Fi Permit is valid if signed by City Official PERMIT EXPIRATION DATE(90 days from approval date) °A) 2s---& PRrj City of Prior Lake RECEIPT 4646 Dakota Street SE Prior Lake MN 55372 952-447-9840 \ / Received Of: Receipt: 6237 Ryan W.West Date: 07/19/16 Customer: Ryan W.West Receipt Item Receipt Description = GL Number = Total Driveway Permit 16781 Wllow Lane Zoning&Subdivision Fees 30.00 Receipt Total 30.00 TENDERED: Checks 3242 30.00 Total:30.00 Susan Zick From: Susan Zick Sent: Tuesday, July 26, 2016 3:29 PM To: 'alissa.r.baker@hotmail.com' Subject: Driveway Permit Application 16781 Willow Ln SW Attachments: 20160726152018008.pdf Please see attached as I need your signature on the page that is marked. If you can, please sign the permit application page where shown and then return it to me via email, mail or into City Hall. Once I have the signature page, I will then issue the Driveway Permit and email you a copy in its entirety. If you have any questions, please give me a call. Thank you, , 3( i t, 1 „I A. Susan Zick .«,0, Development Services Assistant \ CITY OF PRIOR LAKE 4646 Dakota Street SE I Prior Lake, MN 55372 952-447-9830 I szick@cityofpriorlake.com (11 1