4106 Pennsylvania Ave - Zoning Permits & PlanstyofEaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5685
Fax: (651) 675.5694
Email: piannino6citvofeaoan.com
For Office Use
Permit #: //7o
Date Received:
ZONING PERMIT APPLICATION
- p Please identify improvements on a scaled site plan drawing that shows lot lines, structures
and existing conditions.
PROP If
site Address: U/ I V o 1 ri A5/ I VC{ Of / I- (AC.-
Owner Name: V e 64
CONTACT
Name: i C_�' \ 'E~' .� / L env
60(2`16
J ,. 5 C" JState/P
Address: -I-7 ►tY
1 � 1Z
e55 (o'er
ill Prat
_
Date: t _.-�
Applicant Signature:
Email address: -5 cc `J• E. v' r de t(--‘ t ael aclA C) i Cep
"'•I•Yp
❑ RetainingWall <4 feet i?'1.Drivewa Y 0 Other.
0 Patio . 0 Sport Court
❑ Sidewalk IQ Fence c-'
Description of work R (c`� '.Y t' (.o L(' 1 C 19 G,.r��
: PLANNING .
Setbacks. hard surfacer covetrage, shoreland zoning, uffzone/setbacks,
Approved / Denied
Notes:
•
Date of Approval: , 7 jIStaff. (r
Property lines to be verified
by contractor/owner.
C.e \ iS 7 (01MP1hC1,-
1
Revised Plans
Approved:
Yes / No Date of Approval: Staff:
ENGINEERING
Grad'mg, drainage, utility easements, wetlands, erosion control, improvements in the Right -of -Way, etc:
Approved / Denied
Notes:
Date of Approval: Staff:
Revised Plans
Approved:
?es / No Date of Approval: Staff:
COS
,
yVy
:I
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call .
48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.org
G:18uilding Inspections1PERMIT APPLICATIONS1201112011 Permit Applications
SIGN AND RETURN WHITE COPY
Date:
Name:
RICHFIELD
BLACKTOP
lri �? tit• yc2rd,
- The Twin Cities Paver of Choice -
ESTIMATE By: 41grit #6$'1- 071V-Vc-17Y
17- a�
Address:
City: I
❑ Phone
it/Cf 5CArICSI4y L
Y(e6 pe 4i7Sy/yawq r e Bp
QSY/7 41i Zip: 55 /2)
77c,)3
0 Phone
Velermit if needed
remove Asphalt (Extra charge if over 4")
❑ Remove Concrete (Extra charge if over 4")
O Apron removal 1 car 2 car 3 car
a -Cap Blocks c (Does not include foundation work)
❑ R move Gravel, Dirt or Sod
19 Base, after compaction
O Your existing base and ours
I'] R. rade for proper drainage - asvation�y . (See > Hot Mix Asphalt compacted to
❑ Addition to drive
❑ Concrete, see concrete form
r -Approximate Square feet /Ivo 7
1]-Backfill: Homeowner
' 5 Yr. Warranty (see details on back)
Yr. Asphalt Protection Plan (see details on back)
Options: (Not included in esitmated cost)
O Fabric Installation SF $
❑ Permaloc LF $
Customer Initial
Estimated Cost:
Down
Balance
stomer Approval
Date
I have read and agree with the terms and conditions on the reverse side.
Property lines to be verffl
by contractor/owner.
❑
❑
❑
❑
RICHFIELD
BLACKTOP
/// -70
2019
SUPER SERVICE
AWARD
BBB.
ACCREDITED
BUSINESS
No
Replace as is ❑
Flares ❑
Stumps/Roots
Yes
CUP
No Yes
Water shut off El -
New Cover 0
Drainage Problem ❑
❑ Design on ssparate copy— LSprinkler heads? Property Line?
c`
eV
�t,e,tvAC
tog
5274?-0- t\L) 'ocK
7745 2nd Avenue S • Richfield, MN 55423 • Ph: 612-866-8836 • Fax: 612-86
Licensed • Bonded • Insured
8078 • www.richfieldblacktop.com