HomeMy WebLinkAboutExcavating & Filling Permit - #10-G-12 �� PRtp�
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� �� EXHIBIT A ��
FOR CITY USE ONLY
EXCAVATING AND GRADING PERMIT PERMIT # �d --� Z
DATE �j-Zl-/o
Applicant: � �� � �►'� L ' Phone # 7� 3 ',S31 - o? � �
Project/Development Name if Applicable: `i'�- Vl �(.,$ o I� o' w l� 0 Lu�
Address: �
Property Owner: � � � "" ' "�s t � L ' Phone # ? � 3 ' � 31 �� � �'f'
Add�s: q? a 5 —� 3 L A�v{-1�'0 . rvl� lR. ��6v-C h S 3 6�
co►����: 1�Jrr r� �1' ��►�, c.. Pn�,e # 7G3 - S3 �—o� (�
address: ? 0 5 �' N'o. ��'dY� h SS 3�P
Consuitant Engineer/Surveyor. 1_ / I"� Phone #
Address:
Emergency Contact (24 hr): �� �� � Phone # � � 2 �� � 1 ^ � ��
�ocation of Property: �' c� � 3 �— � � .� ��. 1- � �. �-�Q .
Legal Descxiption: � S 2 3 � v �- � h. 5 �,l B�l Olq/$ ,
Will the excavation or fitling be in a: Watercours�e �-�^— Wetland � , �Ug lan �
Purpose for the proposed excavati� or filling: J�l �"' � 'e-� �'�- y�a. �`� �a� ��K.� •
Estimated start date: .� C mpletion d e: �
What is the type of material to be removed or deposited? V`t- t? � s
What is the quantity of material to be removed or deposited? � 7 Gv
What is the total area disturbed for excavation or filling?
In what manner will the material be removed and/or deposited?
What highway, street or other publio-way will material for removal or deposition be hauled or carried?
What, if a, s�y treet, avenue, lane, alley, highway, right-of-way, thoroughiare or public ground will be obstructed?
1i17V�.Q �
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION
OF THE CITY 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 WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL
ENGINEER.
wll proposed excavation or deposition affect the City of Prior Lake overall storm water management plan? Yes No �
If yes, explain proposed effect
SUBMISSION REQUIREMENTS:
(A) Completed application form
(B) Map or plat of the proposed filling or excavating showing location and amourrt of material proposed to be removed or
deposited, with a description of the ar+ea
(C) The depth or heights to which such removal or deposition is proposed throughout the 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 original coMours shall be
G:4ldmin�PW Deaign Mmua1�2007 PWDM iIPDATEIE7CEIIBTT A APPI.ICATION FOR EXCAV @ FII.LING.doc .
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h+�iyyi� tt �HIBIT A ff
FOR CITY USE ONLY
EXCAVATING AND GRADING PERMIT PERMIT # �o �-� Z
DATE - Z!-/o
Applicant: � �^R- � � � L • Pnone # � ?�0 3 -,S 31 I �
Project/Development Name if Applicabie: ` Vl aCs �� � w �u.K.o !N'�
AddrBSS: �
Property Owner. � v � "" "'�-s l '� L ' Phone # � � 3 '� 3 � �� � �"'�
nad�s: 9? o S� G�3'' A�r{- I�o •�� �►-�� h S 3�O �
Contrador. �� 1'� �1�^�-f � 1�'l. C� . Phone # 7�i 3 ' S 3 I"� 1 ��'f '
Address: � 0 5— �' N'b. � rcr� h SS 3�P
Consultar�t Engineer/Surveyor. ( ' / � Phone #
Address:
Emergency Corrtact (24 hr): �'^"� ` � � Phone # � � 2 �� � 1 ^ ` – ��
�ocation of Property: ��� 3 Z— c� �� ��. 1- � s�. �(Z-�Q .
Legal Descxiption: I�° S 2 3 � v Z— � h.5 ��01N$ ,
Will the excavation or filling be in a: Watercourse �� Wetland � U lan �—�—
Purpose for the proposed excavatin w filling: Y 0 '�-X C'�'' �. �� a� y� y�'►�,�� •
Estimated start date: � C mpletion d e: �
What is the type of material to be removed or deposited? V`�, o � S
What is the quan6ty of material to be removed or deposited? � 7 Gv
What is the total area disturbed for excavation or filling?
In what manner will the material be removed and/or deposited?
What highway, street or other publi�way will material for removal or deposition be hauled or carried?
What, if ap , sy treet, avenue, lane, alley, highway, right-of-way, thoroughfare or public ground will be obstructed?
11��e _
IT SHALL BE THE RESPONSIBILITY AND THE BURDEN OF THE APPLICANT TO DEMONSTRATE TO THE SATISFACTION
OF THE CITY ENGINEER FOR THE CITY OF PRIOR LAKE THAT TNE 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 WITH SUPPORTING CALCULATIONS OF A REGISTERED PROFESSIONAL
ENGINEER.
Will proposed excavation or deposition affect the City of Prior Lake overall storm water management plan? Yes No �
If yes, explain proposed effect
SUBMISSION REQUIREMENTS:
(A) Completed application form
(B) Map or plat of the proposed filling or exqvating showing location and amourrt of material proposed to be removed or
deposited, with a descxiption of the area
(C) The depth or heights to which such removal or deposiGon is proposed throughout the 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 original corrtours shall be
G:\Admin�P'W Design Mmua1�2007 PWDM UPDA1�'1E}�IIBTT A AFPI.[CATION FOR EXCAV & FII,LING.doc
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