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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? 1020 <br />Job Address <br />Bldg. Permit No. <br />Legal <br />1 Descr. <br />Lot No. Blk. <br />3 <br />4 <br />5 <br />6 <br />Owner f 'Mailing Address <br />Applicant /� Mailing Address <br />�'/�j,/� `1 VA <br />IF or Eng. - Mailing Address <br />Tract <br />%rrif A21f E 17,55 fltOrs' /U/ l Se K <br />Attached Sheet <br />Zip Phone <br />Zip <br />gift) <br />Contractor Mailing Address <br />T <br />�C /%ca �At71p L�� <br />Pu ose of Fill or Excavating <br />b orb 6/7 <br />Zip <br />7 <br />Phon <br />/J 6e S7 o <br />Phone <br />A / 9 a P h o y ne 1 / 7 7 / Hag 7 97.37 <br />T,Re % Zffd- I <br />Type and Amount of Flip pr Excavating <br />REF O itI <br />Special Conditions <br />310 s <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 />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 cultic 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 (g) $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 />1or 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 Owner If Owner Contractor) <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 82 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />