HomeMy WebLinkAboutDemo Permit 13. 0898 J
0 W Z 1r
a ❑ a - t W. LL z w
- , <) g o y a. a w W ❑ ` z 0
w Q (3`' c��ww
"` -" W 0 E. u. 0 \ 2 z
w
0�' 0000 019,., w
M w °
CV w L z O r
W z _ » ? ( - � 1 �� J z 0 0 W y
I- lY O O LL J _l • t . , ., O a� w QC
o I 0 0 0 0 a �C,i 0 c a a °
• Q Z ce z —xxZ? +� Z w cn
4, U 0 w m�am ` 1 •r� a z b • 0 �'
0 0. g V I- w � v �"
O 0 z f O
I 0.2 co a. I `. �, w w W ii
O 0 Z
0000❑❑ 'o
'4"-) Q\ 0 0 o w 1
f `1 `• ,. 4. Q. LL 1-- y 1\'l Q 0 a U 0
F- Z O •
U f"
oil. Q �� ti c,1 0 Z O z 0 w F - Q r I 4 a
Z cn W
cell co O ?~ o? z W Y z z o Q A
u.V w El W ~Z <DQ 2 0 a C U U
Ow w Oo u'z1- O O v
z
% 0 oo 3 0 0 c
c)?
0 0 a 0 ❑0 ❑00 0 4❑❑
(s � PR /04), CITY OF PRIOR LAKE ''' Date Rec'd
. DEMOLITION PERMIT
•
4r jNNB S O`S
•
PERMIT NO.
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
L f Z l 40 ' S.E . ME • Rr: or Cam w+n 6753 Z
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID a,5'1,23
OWNER C. r
(Name) e - Prior- I4k . (Phone) q "' `i B `i " 8K v
(Address) y (o M (p De. {L 44 . C. of Win SS L
CONTRACTOR Et c 0 � ` «- — - C f Z— Z Z- G YS
(Company Name) (Phone) y
(Contact Name) �� D "" eir�. (Phone) 7S Z' Zq Z - 4 /5 - 43
(Address) sj LI oS- CcA.- tct /c, S S
Use of Building: ) INTERNATIONAL BUILDING CODE •
� Type of Construction: I II III IV V A B
1 1 1 CtilLe Occupancy Group: A B E F H I MR S U
Division: 1 2 3 4 5
E MPCA NOTIFICATION OF INTENT TO PERFORM A DEMOLITION •
I hereby certify that I have furnished information on this application which is to the besCbf 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 ac • :. - - ith submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore,
• I hereby agree • icial or a designee may enter upon the property to perform needed inspections.
63/i3h 3
• Signature Date
METRO (DICES) SAC UNIT
This Application Becomes Your Demolition DETERMINATION
/ Permit When Approved `
_ 6 , Uf
:nil•' gOfficial Date
This is to ,l: ,•fy t : the request in.the above application and accompanying docume s is in a. ordance with the City Zoning Ordinance and may proceed as requested.
At g
• .•„. - _ - - • Date Special Condi if any
•
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
16200 Eagle Creek Avenue, Prior Lake, Minnesota 55372
•
•
•
•
•
•
Minnesota Department of Health SEALING NOTICE VERIFICATION
M I N N E S O Y A Well Management Section
M 1II P.O. Box 64975 This is to verify that this office received a notification on 9/16/2013 that a well
St. Paul, Minnesota 55164 -0975 (Minnesota Unique Well No. 0000427115) is to be sealed by
DEPARTMENT oF HEALTH (651) 201 -4600 or 1 -800- 383 -9808 BOHN WELL DRILLING CO., INC. at:
Well or Boring Location Address: 4262 140TH STREET NE PRIOR LAKE 55372
Location: Township Name PRIOR LAKE No. 115 Range 22 W Section 23 SE NW SW
This well must be sealed in accordance with the Minnesota Rules on Wells and Borings. 61( MDH staff may be on site to inspect the well sealing.
PRIOR LAKE, CITY OF ' I 1'J # \3
4646 DAKOTA STREET SOUTHEAST
PRIOR LAKE, MN 55372
SEA' 2 0 2013
By
. (.. 5 g . ',.:
r pi:;.SEUKRig:00.:,,,:,:z.,:fin41;::INeg:•:;::'..,:liKii..:::`U.:::::.;,',...,'A::;::,'::,,,,,::k;,,:,'..:.,e:,:':,i'.A::::;:i:,,:j.;,,',..,'..1:iM;',::;:li.:;',Ki,..;::.:,:;MR:giM.;,;tig:11,9it);M:gialh*egtagilernitP4';'2 7.T.,(44V*Sliggin0ag:1:0;r. \ :'
... „ :r... M ,,, ,: f i ,, -a ,e r.� Y ,� sty
SCOTT COUNTY, MINNESOTA
Permit #
INDIVIDUAL SEWAGE TREATMENT SYSTEM (ISTS) PUMPING PERMIT
Owner .¢. . 1 fU i e,
��`.�. of � �' Address �° i , .. +,. �� ,
Pumper I \k,,,.0 ` -4) II L No. of Tanks Pumped p / Total Gallons Pumped / 00C)
Check all that apply: ❑ Residential ❑ Commercial
❑Rental
111 Septic ❑ Holding ❑ Pump Chamber ❑ Cesspool p ❑Abandoned El Other:
Condition of Baffles (baffles must be inspected) ❑ Acceptable p [j] Unacceptable C Replaced Baffles
Depth of sludge layer inches
Disposal Location (be specific)
Did you observe a surface discharge? Ill Yes [] No
Pumped j
P ed From: ❑ Maintenance Hole E] Removed Removed Tank Lid (stave, for exam I
p ) ❑I nspection Pipe (see below)
�
I have been informed about the correct tank cleaning procedures and understand that I risk having my system fail prematurely
if the tank is not pumped through the Maintenance Hole / Tank Lid to enable the removal of solids. !
Signature of Owner / Owner's A ent }
Com Reason for not pumping through the Maintenance Hole / Tank Lid
menu ■
t 1 SJ .i 1
Pumper /Inspector Signature f
# Date t j `_ t.w) � :'
Only one permit is needed per ISTS. If there is more than one ISTS`on a property, submit a separate permit for each ISTS.
Submit a permit whenever a tank is pumped for abandonment. Pumping the tank does not constitute a compliance inspection.
County White -
Canary - 'Homeowner Pink - Pumper
Form #1120
•
.
Site Restoration Proposal For Demolition
C.) try
Applicant: C� r :c,r LA
Address: • 4- 1Z4 , Z. 140 t4 .
Check boxes below:
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.
X Call City of Prior Lake Public Works Department (952.447.9898) for water meter
removal. k) IA
,` Cap gas line.* (By gas company)
A Disconnect electric at meter. (By electric company)
/ et' Pump and fill cesspool /septic tank. Certified contractor required.
or Abandon well. Certified contractor required. Existing well
Remove existing structure foundation and footings, materials, and debris. **
❑ Provide dust control by following means:
1. Water mist from a water supply (i.e. neighbors, water tank)
2. Enclosure
3. Other
Comments: (provide survey or draw site plan)
*Capping of utilities must be inspected.
* * Final inspection and approval of restored site required. Deposit will be returned after
approved final ins.- 'on.
4101101 //CA
'Signature Date
J:\BUIL P G \HANDOUTS\Demolition Restoration.doc