HomeMy WebLinkAboutDemo 07-0335
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CITY OF PRIOR LAKE
DEMOLITION PERMIT
'S" / "2- / :a~ Rec'd
at bottom)
I PERMIT NO. ()(p .03351
ADDRESS
ZONING (office use)
.\/V
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ~5>--
OWNER
(Name)
(Address)
s Y)'\ S e....
;;)
(Phone) 01 d - (j fa ~l --l:, 9 fr4
") ;)....
CONTRACTOR
(Company Name) S Th ~ t-
(Contact Name)
(Address)
(Phone)
(Phone)
Use of Building:
INTERNATIONAL BUILDING CODE
Type of Construction: I II ill IV V A
Occupancy Group: A B E F HIM R
Division: \. e.. C-. 1 2 3 4 5
MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION
B
S U
I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that
I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws
and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
I her ree that the city official or a designee may enter upon the property to perform needed inspections.
C:'
~- '0> -0 {o
. Signature
Date
This Application Becomes Your Demolition
Permit When Approved
~ ~ C;-/G~ Co
Building Official ' Dale
e application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested.
S"'J...oi'
Date
Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
Site Restoration Proposal For Demolition
Applicant: 0 /VI s C
_L~. _/. /_/Jf
Address: d.55CJ ~ (a-.t:
Check boxes below:
;t~~~ ~,
S- 55 7.::L
Fill Excavation to grade
Sod or seed all bare soils
Erosion control (see handout). Maintain erosion control until turf is established.
Cap sewer below grade. * Mark location. Licensed contractor required.
-"'...,Cap water below grade. * Mark location. Licensed contractor required.
J' lCall City of Prior Lake Public Works Department (952.447.9898) for water meter
removal.
~LCap gas line.* (By gas company)
",/Disconnect electric at meter. (By electric company)
r:t; Pump and fill cesspool/septic tame Certified contractor required.
f! . Abandon well. Certified contractor required. Existing well
;/ Remove existing structure foundation and footings, material
oI"Provide dust control by following means:
1. Water mist from a water supply (i.e. neighbors water ta
2. Enclosure
3. Other
Comments: (provide surveyor draw site plan) ,r
~f r ~~~~~ "1 ~ ~-'
~~ 1J ~~~~~Z~^~
~~ I C~-~ CAJ-::r-~~ ~' ~ ~ ~
~~~ ~ ~ -::r-~--:J i
*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required. Deposit will be returned after
nved ~ction.
~ 5-o-.~O~
Signature Date
J :\BUILDING\HANDOUTS\Demolition Restoration.doc
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"";' /'7",.,.
\ '\v. va 1 ~ un.., .l UII.f'I't::U I'
. U ldl "-WAU VJJ03 ..I. U III flC'U
Check all thai apply: ~~1Zc~mkIlLial D Comml:n;ial DRcnlal
L1d Scplll: 0 IIllJding 0 Pump Chamber 0 Cesspool 0 Abandoned 0 Other:
Condition of Barnes (haftl.:s ml1st he impedeu) 0 i\c(;cptahk 0 Unacceptable;: D Replaced BaHlt:s
Depth of sludge layer
Disposal Location (be specific)
Did you observe a surface discharge'! 0 Yes 0 No
Pumped From: 0 MaintcnHI1l:c Jlok 0 Remon:d T.U1k Lid (sta\c. for example) 0 Insp~ction Pipe (see below)
r ha\'C bc~n infon11Cd about the correct lank ck;]lling procedures and understand that I risk havi~g my system fail premall1rcly
if the tank is l10t pumped through lht.: Mainknanec J [ok / Tank Lid to cnahl~ the removal of solids.
inches
"
Comments c',_/_..'
(. .. ,
Pumper / Inspector Signature ~-',-_... .--
(.) I 't' d d p'r Isis': It'th"rc l'~ mqrc (l1'm one ISTS on a prol)ert)'. submit a scparato permit for each 1ST. S.
n y ont.: perml IS m:c c <: . -1. . ~,~, . t .', . > . ..'
Suhmit a pennit whcm:n::r a lank is pumped rur ahandonment. Pumpmg the tank does not constltut", a camphanc!; mspectlOn.
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, I~:cason ~l;;(;tPF'~p~.~ t;:o.~gh t~~_~a/in!~la~fce H(~~c I.bank ~~.~ / /
;"'" ) /1/// /,,//) /f./ /.z,?//-'~l~/' ( i. ! /" " +- ). /' .". /)..j <, I
'. , - ~ , - \... '- - / ,-t,..'!, ,.r 1-,;- /.:.~ ~ II
-.-.." 'Date -I! 1- -"'? 6'".1 /' ,,' v f , ..) 11:1.
Signature of Owner / Owner's Agc.:nt
\VIIlI.: - Count,.
Canary, II(lm~(\wn~r
Pink - Pump.:r
Form #11c[)
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SCOTT COUNTY, lVIINNErTA Permit # " u .,j.J
INDIVIDUAL SE\VAGE TR..:.A Tl\'1ENT SYSTEM (JSTS) PlJhtPING PERMIT
Owner l!/t? ,(.,d~' i-",-, -:;'~). I',' Address / )Cf;5,y; (a ,i~ ~"') /,t},,{J. t~J)
,.. fl>. '/H.. I . .
Pumper ( ,/-r j, c;.~' (' No, of Tanks Pumped / Total GalJons Pumped /;4. (:;/'Z)
Check all that ~Pply: n'Residential 0 Commercial DRcntal
o Septic 0 Holding 0 Pump Chamber 0 Cesspool 0 Abandoned 0 Other:
Condition of Bame~ (baffles n1U.~t be inspected) 0 AC(;l,;ptablc.: 0 Unacceptable 0 Replaced Baffles
Depth of sJud::e layer
Disposal Location (he specific)
Did you observe a surface discharge?
Pumped From: D Maintenance Hole
inches
DYes
o No
o Removed Tank Lid (Oitave, for example)
o Inspection Pipe (see below)
I have been informed about the correct lank ch:amng procedures and understand that I risk having my system fail prematurely
if the tank is nol pumped through the Maintenance IIoJc / T anI\: Lid to t:nabl e tho::; removal of solids_
.,)
Sifinaturc'of Owner / Owner's Agent )' / R;'a~on for n~~ rumpmJhrqU~h,the M~'!!pt~fiance Hole! Tank Lid
\/'/.( '-<./, 1 ' : -\;1 c I.d",.;;- /,~" .-/
""\"'1-/ : /,' UC / /' J (/, /:;'y' /)'[/-' (
Comments / J _....,;: . / 'C' C - /' r #
Pumper / Inspector Signature I //J.. . _-----.-------. '''Oate ,~? :/:?-,d ci-
Only ol1e permit is needed pcr lSTS. Ifth~r~~(iri;f~~~.i~;-:: rsrs on a property, submit a separate permit~or each ISTS.
Submit a permit whencver a tank is pllmp~,9--tor ahandllnmenl. Pumping the tank does not constitute a compliance inspection.
i_//
Whit.: - County
Callary - HOnl,:owTIIJr
Pink -- Pumper
Form ~1120
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