Laserfiche WebLink
Authorization of Permit Page 1 of 2 April 2024 <br />PERMIT NO. <br />CITY OF LAKE ELMO <br />3880 Laverne Avenue North <br />Lake Elmo, Minnesota 55042 <br />Phone: 651.747.3900 <br />AUTHORIZATION OF PERMIT (Office Use Only) <br />Upon payment of permit fee in the amount of $ and in consideration of the agreement to comply in all <br />respects with the applicable ordinances and regulations covering such operations, permission is hereby granted for <br />the work to be completed as described in the attached application. Said work shall be completed in accordance <br />with requirements listed on the back of this form and special precautions required, as hereby stated: <br />Field Staking: Work under this permit must be field staked and approved by the City prior to <br />commencing construction. <br />Joint trenching is required for this installation. <br />No paved surfaces are to be disturbed by this work. Installation under paved surfaces shall be done by <br />boring or jacking. <br />Underground construction must be installed so it will not harm or unnecessarily destroy the root growth <br />of trees. <br />Draintile shall be installed in accordance with City Details. Connection to catch basin/manhole shall be <br />core drilled. Please call Public Works at 651.747.3941, a minimum of 24 hours in advance to schedule an <br />inspection of connection to catch basin/manhole. <br />Additional Provisions: <br />Approved By: Date: <br />Fee Received: Date: <br />Inspected By: Date Approved: <br />Record Drawing Received: Date: <br />NOTE: General Requirements of the Permit are listed on page 2 of this Form.