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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 />^oplicant to complete numbered spaces only. <br />N? 1024 <br />Job Address <br />013 S--/ <br />Legal <br />1 Descr, <br />Lot No. <br />3 <br />GRttN8 /E2 et ac t TiT#fii-'6a`_lrpytl w <br />Blk, <br />Tract <br />bkcHAaME <br />Owne <br />2 JaHA/ GR ^attycK <br />Applicant <br />3 SAM/i <br />Mailing Address <br />a3S4' Gge)Narut,L 6/2 <br />6e.42010 j Ue /w <br />Zip <br />ss //l <br />Bldg. Permit No. <br />See Attached Sheet <br />ailing Address Zip <br />Phone <br />4 %1/ -aaa s <br />Phone <br />Architect or Eng. Mailing Address <br />4 <br />Zip Phone <br />Contracto <br />5 <br />Mailing Addre <br />Zip Phone <br />Purpose of Fill or Excavating <br />6 TO ELfM/NAre <br />�IIAT .- TRAP THAT HA3 <br />f3/` -EA/ e/CrAreb /ai QAc c /4 it <br />Type and Amount of Fill or Excavating <br />7 J /Odd Cus/c yiabs <br />Special Conditions <br />N%Ei> 7o RA ISr LEVcL <br />OP y4 R b he TO fr.L /EVE, 771A-T— M» S <br />bo = To /JEl6Haore /tut Lo-T_ ARr-A <br />TRAPPFI> /N S,p, -cic <br />RUN -(1 <br />LWA -Tf /S Al C, Qf /Ai& <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 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 />2. Reinspection fees assessed under provisions of <br />Section 305 (g) $30.00 per hr1 <br />$30,00 per hr1 <br />$30.00 per hr1 <br />3. Inspections for which no fee is specifically indicated <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 />Si nature vgf Contra for or 1 uthoriz:. Agent <br />ignature of Owner (If •wner Contractor) <br />(Date) <br />g <br />yDate) <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 -8- <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />