RESORT VILLAGE OF SOUTH LAKE
EXCAVATION PERMIT APPLICATION
Date of Last Revision – MARCH 18, 2015
1. APPLICANT’S NAME (Printed):
LAST NAME
FIRST NAME
2. APPLICANT’S PRIMARY ADDRESS (Printed):
ADDRESS
CITY/TOWN
PROVINCE
POSTAL CODE
3. APPLICANT’S PHONE NUMBERS:
HOME #
CELL #
WORK #
BLOCK
PLAN
4. LEGAL LAND DESCRIPTION:
LOT
5. RESORT VILLAGE OF SOUTH LAKE ADDRESS:
6. EXCAVATION PERMIT REQUEST TYPE:
CHECK
WHERE
APPLICABLE
DESCRIPTION
Initial Permit
Subsequent Change to Initial Permit
1
RESORT VILLAGE OF SOUTH LAKE
EXCAVATION PERMIT APPLICATION
Date of Last Revision – MARCH 18, 2015
7. ADDITIONAL PERMITS OBTAINED:
CHECK
WHERE
APPLICABLE
DESCRIPTION
Building
Septic
Other - attach list of
8. CONTRACTOR CONTACT INFORMATION IF APPLICABLE (Printed):
LAST NAME
FIRST NAME
COMPANY NAME
ADDRESS
HOME #
CITY/TOWN
CELL #
2
PROVINCE
POSTAL CODE
WORK #
RESORT VILLAGE OF SOUTH LAKE
EXCAVATION PERMIT APPLICATION
Date of Last Revision – MARCH 18, 2015
9. PURPOSE FOR THE EXCAVATION PERMIT (attach additional sheets if required):
(Note the type of machinery that will be used to perform the excavating)
10. IF A GEO TECHNICAL REPORT HAS BEEN ISSUED PREVIOUSLY ON THE
PROPERTY TO BE EXCAVATED, PLEASE ATTACH THE COMPLETE REPORT
TO THE PERMIT APPLICATION
11. TYPE OF MATERIALS TO BE EXCAVATED
CHECK
WHERE
APPLICABLE
DESCRIPTION
Soil
Trees and Shrubbery
Grass and Vegetation
12. DESCRIBE WHERE, WHEN AND HOW THE EXCAVATED MATERIAL WILL BE
DISPOSED OF (Printed):
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RESORT VILLAGE OF SOUTH LAKE
EXCAVATION PERMIT APPLICATION
Date of Last Revision – MARCH 18, 2015
13. EXCAVATION DATES:
DESCRIPTION
DATE
(MM/DD/YY)
Expected Start Date
Expected Completion Date
14. APPLICANT’S SIGNATURE
DATE
(MM/DD/YY)
SIGNATURE
15. OTHER NOTES (Printed):
4
RESORT VILLAGE OF SOUTH LAKE
EXCAVATION PERMIT APPLICATION
Date of Last Revision – MARCH 18, 2015
OFFICE USE ONLY
CHECK
WHERE
APPLICABLE
DESCRIPTION
Permit Fee Received - $100
Permit Fee Waved/Reduced - attach
approvals
Plot Plan Received - location of buildings,
septic/cistern, power lines, natural gas,
telephone lines, access roads and the area
to be excavated clearly marked (in feet
from property lines)
Actual Photos Required/Provided
Geotechnical Report Required
Lot Survey Required
APPROVALS:
1. RESORT VILLAGE OF SOUTH LAKE
APPROVAL
DATE
(MM/DD/YY)
SIGNATURE
5