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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° 1001 <br />Job Address <br />/0 `4/ C ° ±r� <br />Bldg. Permit No. <br />1 <br />2 <br />3 <br />4 <br />5 <br />Legal Lot No. Blk. <br />Descr. ._ G <br />Tract <br />, emei- /Ws, <br />Owner Mailing Address <br />�I'✓l Ase AA✓A 4 ILGK /,t' <br />Applicant Mailing Address <br />Zip <br />See Attached Sheet <br />Phone <br />Zip Phone <br />Architect or Eng. <br />Mailing Address <br />Zip <br />Phone <br />Con tractor //'� Mailing Address <br />,61 ° /7LL Al 4✓t <br />Zip <br />Phone <br />Purpose of Fill or Excavating 1 <br />6 f0 elev4tt l k 71,7 rf f '✓7 744 v Ar f /4It Live / <br />Type and Amount of Fill or Excavating <br />7 YAPNA7 c.17 <br />Special Conditions <br />4/0 ,,'4 t- <br />/lo K 44e4i y�v <br />oo gy yof. <br />i4/ <br />mf4A.4 6, fa z ✓/ aiv /fr <br />PERMIT FEE$ VJJ3" t.(tofYit.. y51 °Q <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 />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 <br />(minimum charge —two hours) <br />• <br />2. Reinspection fees assessed under provisions of <br />Section 305 (g) <br />3. Inspections for which no fee is specifically indicated <br />(minimum charge — one -half hour) <br />tor the total hourly cost to the jurisdiction, whichever is <br />This cost shall include supervision, overhead, equipment, <br />and fringe benefits of the employees involved, <br />$30.00 per hrt <br />$30.00 per hrt <br />$30.00 per hrt <br />the greatest. <br />hourly wages <br />Si.. azure of Owner ( e ner Contractor) <br />WHEN PR <br />- 31-P1� <br />(Date) <br />CITY OF <br />LITTLE: CANADA <br />RLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE — Inspector <br />CANARY — Customer <br />INK—Of (ice <br />Permit Validation Ck MO <br />Total Fee Collected $ L,YV' o <br />By <br />`1(�/ <br />