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CITY OF LITTLE CANADA
<br />515 East Little Canada Road / Little Canada. MN 55117
<br />FILLING AND GRADING PERMIT APPLICATION
<br />Applicant to complete numbered spaces only.
<br />N° 1092
<br />Job Address
<br />)Xxx. Rrcc sr /et-T
<br />Bldg. Permit Na.
<br />7Z, de- ,Mama z1 /co e.
<br />Legal
<br />1 Oescr.
<br />Lot No.
<br />81k.
<br />Tract
<br />eU s77-/oO,2,C5 Z`vO 4o4,tl
<br />See Attached Sheet
<br />Owner Mailing Address Zip
<br />2 DAIJF,z.hi, /Nc. 35'86 », 12-xrN4raJ 5dITF Z70 -4A4e1 !!acts 5f z&
<br />Phone
<br />/2- 414 -,3341
<br />c etc_
<br />Applicant Mailing Address
<br />3 54-r
<br />Zp
<br />Phone
<br />!n5l- 48/ -/v440 OF -Pica
<br />Architect or Eng,. Meiling Address Zip
<br />4 PCowe EN4011 P-1N4 9/80 teZf,if°Ind $em&)r— C,RCCe Av& 5333/4
<br />Phone
<br />.6 /Z -785--1043
<br />Contractor - Cx CM)AflON Mailing Address Zip
<br />5 2oy4-L FXu}v44 -rro,J 9196 ce-xrrv4roxl — sfoR (GW 5-5-7 zb
<br />Phone
<br />( 0 5 7 g - 5 - 5 7 6
<br />Purpose of Fill or Excavating
<br />6 54-Rcv Sr/,¢.r ro /!atom &infl-et. e0,e/0 rnem/5
<br />Type and Amount of Fill or Excavating
<br />7 rzEr ,P.cl,uo(14- G /o /SPosd -'- 6, Cfn/uc,Se — &5n e" /3,4hre) yoj
<br />Special Conditions
<br />8 AO—EP 5,>— , ,C vnc/r / &s, Cu/ /3 .. ( /re* . ,4.e-7-4N/ a//1 -us / 5r G /F-r ac
<br />45Ah'AGr ro ,¢r/D /O /tu/A tR— come /T70,v5 -- 77/ 7—Mier 9 of 7=5 ry
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<br />PERMIT FEE $
<br />NOTICE
<br />This permit becomes null and void if filling or grading authorized is not
<br />completed within 180 days, or if filling or grading is suspended or
<br />abandoned for a period of 180 days at any time after work is com-
<br />menced. Any work not completed within 180 days requires a new permit.
<br />I hereby certify that I have read and examined this application and
<br />know the same to be true and correct. All provisions of laws and
<br />ordinances governing this type of work will be complied with whether
<br />specified herein or not. The granting of a permit does not presume to
<br />give authority to violate or cancel the provisions of any other state or
<br />local law regulating filling or grading.
<br />D4Vrz /mot 4Y ,,
<br />50 cubic yards or less 515.00
<br />51 to 100 cubic yards 22.50
<br />101 to 1,000 cubic yards - $22.50 for the first 100 cubic yards,
<br />plus $10.50 for each additional 100 cubic yards or fraction thereof.
<br />1,001 to 10,000 cubic yards - $117.00 for the first 1,000 cubic yards,
<br />plus $9.00 for each additional 1,000 cubic yards or fraction thereof.
<br />10,001 to 100,000 cubic yards - $198.00 for the first 10,000 cubic
<br />yards, plus 340.50 for each additional 10,000 cubic yards or fraction
<br />thereof.
<br />100,001 cubic yards or more - $562.50 for the first 100.000 cubic
<br />yards, plus $22.50 for each additional 10,000 cubic yards or fraction
<br />thereof.
<br />Other inspections and Fein:
<br />1. Inspections outside of normal business hours $30.00 per hr
<br />(minimum charge -two hours)
<br />2. Reinspection fees assessed under provisions of
<br />Section 305 Igl
<br />330.00 per hat
<br />3. Inspections for which no fee is specifically indicated . 330.00 per hr i
<br />(minimum charge - one-half hour)
<br />for the total hourly cost to the jurisdiction, whichever is the greatest.
<br />This cost shell include supervision, overhead, equipment, hourly wages
<br />and fringe benefits of the employees involved.
<br />Signature of Contractor or Authorized Agent
<br />Signature of Owner (If Owner Contractor)
<br />•(Date)
<br />Building Official
<br />(Duel
<br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT
<br />WHITE - Inspector
<br />CANARY- Customer
<br />PINK - Office
<br />Page 30
<br />Permit Validation Ck MO Cash
<br />Total Fee Collected S
<br />By
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