HomeMy WebLinkAboutExcavating & Filling PermitCITY OF PRIOR LAKE
Permit No.
APPLICATION FOR
EXCAVATING/FILLING PERMIT
/11
4474230
Applicant
~om~ Owner:
Address:
Phone #
Phone
Contractor: Phone #
Address:
Consultant Engineer/Surveyor
Address: '""--'--
Phone #
LocationofProperty: ! &'~. ~) ~3~Ld~/Y~f-
LegalOescfiption: 5 a7-ol
Will ~e excavation or filling ~ in a: Watercourse
~se for ~e pro~s~ excavating or filling: ~~
What is the type of material to be removed or deposited:
Completion date:
I
In what manner will the material be removed and/or deposited?
What highway, street, or other public way will material for removal or depositation be hauled or carried? ~CO~ '~. {
What, if any, street, avenue, lane, alley, highway, fight of way, thoroughfare or public ground will be obstructed? ~D).-.3 ~C~
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION OF THE crrY
ENGINEER FOR THE CITY OF PRIOR LAKE THAT THE PROPOSED EXCAVATION AND/OR FILLING COMPLIES WITH THE OVERALL CITY
OF PRIOR LAKE STORM WATER MANAGEMENT PLAN. SAID BURDEN SHALL INCLUDE THE FURNISHING OF A REPORT ~ SUPPORT-
ING CALCULATIONS OF A REGISTERED PROFESSIONAL ENGINEER.
Will proposed excavation or depositon affect the City of Prior Lake overall storm water management plan? Yes No _~_ If
yes, show proposed effect.
SUBMISSION REQUIREMENTS:
(A) Completed application form (B) Completed legal description (C} Map or plat of the proposed filling or excavating showing location and amount of ~
proposed to be removed of deposited, with a description of the area (D) The depth or heights to which such removal or deposition is propos~ throughout th~
area and the proposed angle of all slopes to be shown on a 2' contour map at a scale of 1" =50' or larger: The proposed and origitial contours shall be shown in-
cluding all property within 150' of proposed excav~.ion or deposition and shall be signed by an engineer or surveyor registered in the Sm~ of Mi/.(E)
Erosion control plan (F) Affect on existing utilities (G) Pro~ection of site by erection of suitable fence, guard or b~rric~le (H) Application fee (I) Bond, letter of
credit, or deposit of monies in a sum sufficient to pay the cost of restoring a site. The extra ordinary costs of repairing, highways, streets or other public way~
along designated routes of travel and to pay such expenses as the City may incur by reason of doing anything required to be done (J) Public liability in.sur~ge.
Amount of bond Letter of credit, or deposit of money liaJ~iv;~surance provided
Permit tee ~-~ 'caE) '~' ]~'~'OOSignature of aPPlicant k' (~.~~ ~'l_~ Date
Permit deposit City Engineer ..~L~ ~~,,~~~. Date t~
Permit is valid if signed by City Engineer.