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Little Canada, Minnesota <br />APPLICATION FORM <br />Land Excavation Permit <br />\% Land Fill Permit <br />Applicant lt, ?, (-. 17) N L.�.0 <br />(Name) <br />Owner <br />(Address) <br />No. <br />Fee <br />Paid <br />Rec. No. <br />1 <br />(Phone) <br />(Name) <br />(Address) (Phone) <br />Property Location: (Street Address) 7/. ( r� <br />(Legal Description) -i I _. ij _ ' (7( V C/ <br />ATTACH AS EXHIBIT A. <br />Purpose for the excavation /land fill: <br />Where is the fill material from? (Land Fill Permits only) >\./L. <br />What type of material is being excavated /filled? <br />v black dirt; <br />other: <br />sand; gravel; unconsolidated rock; <br />rip -rap; <br />much material is being excavated /filled? <br />List street routes in the City on which the material is to be hauled: <br />Estimated date of completion: <br />Will a security fence be provided during construction? <br />Exhibit B - Attach a site plan showing present topography and also including <br />boundary lines for all properties, watercourses, wetlands and other significant <br />factors within 350 feet. <br />Exhibit C - Attach a site plan showing the proposed finished grade. Included <br />should be measures proposed for erosion control and a final landscape scheme. <br />In signing this application, I hereby acknowledge that I have read and fully <br />understand the applicable provisions of the City Code and current administra- <br />tive procedures. I further acknowledge the fee explanation as outlined in <br />the application procedures and hereby agree to pay all statements received <br />from the City pertaining to additional application expense. <br />61 <br />