Application for Earthwork PermitName and
CITY OF CHANHASSEN
APPLICATION FOR EARTHWORK PERMIT
Contact Person:_
Email:
Phone: 'e6Z-gW-Zq; 9SZ'z[»-�n0�19
Alternate Phone:
Legal Description of subject property-
Lot
ropLot 10 Block _I
Property Identification Number:
Site Address:
of work to
Permit No. Ato -1 �`
Name and Address of Excavator:
Contact
Phone:
Alternate Phone:
Subdivision :ai ke r\
253
0q0,01D
Indicate the use or occupancy for which the proposed w6rk is intended:
V 4/ 4
Estimated quantity of excavation (cubic yards): —f . SO
Attach a plan showing the following. -
1 .
ollowing:1. Present elevations.
2. Proposed elevations.
3. Elevations of neighboring property within 15 feet of excavation.
4. Location of any buildings or structures on the property where the work is to be performed and the
location of any buildings or structures on land of adjacent owners that are within 15 feet of the property
or which may be affected by the proposed grading operations.
I have read and understand the City of C Ben's General Requirements for obtaining a grading/earthmA permit.
Signature of Applicant: Date: //-31/6
Office Use Only
Date Received:
(Denied
$50 Application Fee Received es No
Approved ❑
Receipt No.330&3% Date: —47/1 6
Security Amount:
Processed by: ✓�---_.
Receipt No. 330(079 Date: 7