HomeMy WebLinkAboutDriveway Permit 16-D-22 VRiO�_ City of Prior Lake RECEIPT
• to 4646 Dakota Street SE
Prior Lake MN 55372
rrs ' 952-447-9840
ReceivedReceipt: 6774
Of:
Date: 09/01/16
Joe Dubois
Customer: Joe Dubois
Receipt Item Receipt Description GL Number Total
Driveway Permit 15787 Fremont Ave./16-D-22
Zoning&Subdivision Fees 30.00
Receipt Total 30.00
TENDERED: Checks 1161 30.00
Total:30.00
*Single Family, Multi Family, Commercial , Industrial , Agricultural
DRIVEWAY PERMIT FOR CITY USE ONLY
"Exhibit B" PERMIT# ! , — D'-
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Email completed form to NBriese@CityofPriorLake.com DATE
u % Mail$30.00 check payable to City of Prior Lake to Nate Briese CHECK# )f 61
4646 Dakota St,Prior Lake MN 55372 RECEIPT# 67711
APPLICANT NAME: i 3
OWNER NAME:
PROPERTY ADDRESS: t S "'). "� —xt .n , - %-mo kit-7 ?rS7-314
PHONE NUMBER: 6‘,.) -735- 4 EMAIL ADDRESS: etWo;,. o C r:)c lk.
PROPERTY CLASSIFICATION Single Family Home DRIVEWAY MATERI
*Concrete , a'Ger, 'Other
Proposed width of temporary or permanent driveway �f
(Please provide sketch on reverse side or on separate sheet) i
Is property located within the Shoreland District? Yes
If yes, applicant must submit impervious surface calculation
The driveway is proposed off what roadway?
Is driveway shared by another property owner? (If yes,signature of all parties is required) Yes 103
Estimated Start Date: Estimated Completion Date:
°'\ - - 1(0 -
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
CR!- DRIVEWAY PERMIT
"Exhibit B"
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IMPORTANT_ BEFORE STARTING WORK
EXCAVATOR AND OPERATOR'S NOTICE
This notice is to inform excavators and operators they must comply with
Sections 216D.03 to 216D.07 of MINNESOTA STATUTES
Call Gopher State One
Call (800)252-1166 or 651-454-0002
Or go to www.gopherstateonecall.org
Smart Phone: http://mnticketentrj.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 Applicant's Signature
FOR CITY USE ONLY
7 AUTHORIZATION OF PERMIT
Permit Fee $ . 0' 06
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 thi application and submitted drawings.
ENGINEERING OFFICIAL 'Z Date ,-1 i
Permit is valid if signed by City Official
PERMIT EXPIRATION DATE(90 days from approval date) / Z^/"` /