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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 />lc? 1091 <br />Job Address <br />Legal Lot No. Blk. Tract <br />1 Descr. <br />Bldg. Permit No, <br />See Attached Sheet <br />Owner, <br />2 Ve> /) /Ai.4'1ES <br />• Mailing Address <br />Zip Phone <br />aSEz9. 10‘fnr6M 5-57/7 //57c3--5`3oPl <br />plicant Mailing Address <br />17 <br />3 <br />P <br />iv'f�3 hone <br />g‘a <br />Architect or Eng. Mailing Address <br />4 <br />Zip Phone <br />Contractor <br />5 <br />Mailing Address <br />Zip Phone <br />Purpose of Fill or Excavatin$ <br />6 f//4 /acv .,4`rr%s <br />Type and Amount of Fill or Excavating <br />7 $4A, /y Ga.4ti7 5O/ <br />8 <br />Special Conditions <br />Et-0 y PL) <br />PERMIT FEE$ le1\57) <br />NOTICE <br />This permit becomes null and void 0 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 />50 cubic yards or less $15.00 <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 $40.50 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 Fees: <br />1. Inspections outside of normal business hours $30.00 per hr1 <br />(minimum charge —two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (9) $30.00 per hr1 <br />3. Inspections for which no fee is specifically indicated , $30.00 per hr1 <br />(minimum charge —one -half hour) <br />for the total hourly cost to the jurisdiction, whichever is the greatest. <br />This cost shall include supervision, overhead, equipment, hourly wages <br />and fringe benefits of the employees involved. <br />Signature oof, Contractor or Authorized Agent <br />Signature of Owner Owner Contractor) <br />(Date) <br />(Date) <br />Building Official <br />(Date) <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE—Inspector <br />CANARY — Customer <br />PINK — Office <br />Page 54 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />