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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? 1004 <br />Job Address <br />Legal <br />1 Descr <br />2 <br />3 <br />4 <br />Lot No <br />BIk. <br />Trac <br />Owner <br />S,�Nn44 J. �r's 9 <br />Applicant <br />/� 1 <br />Architect or Eng. <br />Mailing Address Zip <br />—Vs % i11 ,v,+',..seA/ <br />Mailing Address Zip <br />J t/it /77 e,17/SeW 52/" //7 <br />Mailing Address Zip <br />Contracto <br />5 <br />Mailing Address <br />Zip <br />Bldg. Permit No, <br />?/4 61 �- <br />See Attached Sheet <br />Phone <br />Phone <br />' /:?1- n ->t.C) <br />Phone <br />Phone <br />Purpose of Fill or Excavating <br />AFL et cc YxaAl/ <br />CC d',v r C'N as' w»v <br />/ ENI.4e 'fl) AlE /v/ </laAfS TM (4V/d6 i'F <br />Type and Amount of Fill or Excavating <br />C.LE;7v t /i 1 0 y» <br />Special Conditions <br />G) \\\11.-`, I'• <br />PERMIT FEE$ tu` 7/ <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 3J • ' $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 additionar 10,000 cubic yards or fraction <br />thereof. <br />Other Inspections and Fees: <br />1. Inspections outside of normal business hours $30.00 per hri <br />(minimum charge —two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (g) $30.00 per hri <br />3. Inspections for which no fee is specifically indicated $30.00 per hr1 <br />(minimum charge — one -half hour) <br />for the total hourly cost to the jurisdiction, whichever is the greatest. <br />This cost shall include supervision, overhead, equipment, hourly wages <br />and fringe benefits of the employees involved. <br />Signature of Contractor or Authorized Agent <br />(Date) <br />Signature of Owner (If Owner Contractor) <br />Zft,- <br />8 Idi Official <br />(Date) <br />G -S- SC- <br />.ate <br />HEN RO-PERLY VALI <br />(Date) <br />ATED ON THIS SPACE) THIS IS YOUR PERMIT <br />WHITE— Inspector <br />CANARY — Customer <br />PINK — Office <br />Permit Validation Ck MO /Cash <br />Total F�jCollected,$' (I , <br />By <br />