Laserfiche WebLink
CITY OF LITTLE CANADA <br />515 Little Canada Road East <br />Little Canada, Minnesota 55117 <br />(651) 484 -2177 • Fax: (651) 484 -4538 <br />FILLING AND GRADING PERMIT APPLICATION <br />Applicant to complete numbered spaces only. <br />7 0 0 <br />1121. <br />Job Address , _ <br />11'2 l h ...j /`< /2 <br />Legal Lot No. Blk Traci <br />1. Description <br />Owner ,Mailing Address Zio Phone <br />2. (dIIa ale -7 �1 t/Z/ Gt y Aom, 5 1 Li 0 7 6) ( ; r ,., <br />Applicant / /Mailing Address )2) /'i -j.. Zip Phone _ <br />3. J a 4.%\ 7r,} fir:! ( /'r 3'7C. .'r- Cr:,;, - iii . /r_'. ., ,5 )'Y '/ ("j / °- 7 , 7 - i :Y�' <br />c. <br />Architect pr Engineer Mailing Address Zip Phone <br />4. /V &A,'?.- <br />Contractor., _ Mailingp,ddress Zip Phone <br />5. 1 % /- /Ci,,%71 ./. 1 l" Zi £t j!,,� ; I rja2 <br />( <br />Purpose of Fill or Excavatinng�g ///� ,r d µ v . r ; t; r : . .+ sr� /r'- o =o <br />6. r r ; ,K, ,� > 5; e '><'c, /r U 1' i1! r',- r 7,- D r y w r // iM xa .^, C 1'r /72/1,41 <br />Type and Amo�)unt of Fill or Excavating <br />7 S' j k, r ✓o%J' a .� �Gi°I./ % f a r/ (%-q:/i '%f/f 19 P/ / •• x . 4.- / <br />Special Conditions <br />8 A/ fr, /ir_ <br />NOTICE <br />This permit becomes null and void if filling or grading <br />authorized is not completed within 180 days, or if filling or <br />grading is suspended or abandoned for a period of 180 days <br />at any time after work is commenced. Any work not completed <br />within 180 days requires a new permit. <br />I hereby certify that I have read and examined this application <br />and know the same to be true and correct. AM provisions of <br />laws and ordinances governing this type of work will be <br />complied with whether specified herein or not. The granting <br />of a permit does not presume to give authority to violate or <br />cancel the provisions of any other state or local law regulating <br />filling or grading. <br />I 1,/( <br />Permit Fee <br />R -101 -32270 <br />$ 7%, OD <br />State Surcharge <br />G- 101 -20821 <br />e i� <br />TOTAL FEE PAID <br />S 5 i. .f G> <br />/i r/.. <br />Signature of Contractor or Authoraed rat-- Date <br />i <br />5.2 Y (e.) <br />Signature or Owner Of Owner Contractor) Date <br />Puolic woras Director Date <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WI-UTE- Inspector <br />]ANAN Y- Customer <br />RANK- Office <br />3 <br />Permit Validation <br />Ck MO Cash <br />Total Fee Coilecteo 9 <br />3v <br />