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ILLENEf <br />FEB 3 19 .10 <br />City of <br />Little Canada <br />L/ <br />pplicant to c,omplete numbered spaces only. <br />CITY OF LITTLE CANADA <br />515 East Little Canada Road / Little Canada, MN 55117 <br />FILLING AND GRADING PERMIT APPLICATION <br />Inc' 1026 <br />1 <br />2 <br />3 <br />-Sob Address N Xxx CO ,..,,-1 Kg __ >VI IV`t <br />Legal Lot No. 7 Blk. <br />Descr. R-) { s-4 4. c t L. 5 VA b /d4 I i <br />Bldg. Permit No. <br />Tract <br />/.Ak f- <br />Owner A ern c Cac,, Mailing Address <br />sritcc Ca/ /ovA /2511 KF /I9 LL. <br />Applicant <br />":..3 A NA t <br />Mailing Address <br />V,C>�J <br />Zip <br />Huey - 3s> <br />Zip <br />See Attached Sheet <br />Phone <br />43`)— 3 -, 7 <br />Phone <br />Architect or Eng, <br />4 t} <br />Contractor <br />5 <br />Mailing Address <br />Zip <br />Phone <br />54.vx� <br />Mailing Address <br />Zip <br />Phone <br />Purpose of Fill or Excavating <br />• <br />6 -F.o m, a--c- Q K (51- f /9 <br />//4I jo +S ftip "la ki4P <br />Type and Amount of Fill or Excavating <br />7 >= IC` e' yes <br />Special Conditions <br />8 F P4nt, -:f 4 ISA <br />N <br />(Cr <br />C,1y <br />8i 1 t1Ao -Pr lj 'INFJ Up; C LAOS c <br />lete5 et,( (3AuE ecem 55!S,- +3 ([ /I I Stn <br />Ojos.-S Cv }sS4i4.-v) 'iCK_ COP to 4 <br />A.O A CCfSJ <br />—fhA! 11154E wht Acc sf. 413S1/14-c--1— <br />54 .IA.— hA�� <br />but / 4n 'c <br />lhNC � <br />ti r E A 4,,,,/,44)/e. <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 $30.00 per hr1 <br />(minimum charge —two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (9) $30.00 per hr1 <br />3. Inspections for which no fee is specifically indicated . $30.00 per hri <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 Contractor or Authorized Agent <br />(Date) <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 />Permit Validation Ck MO Cash <br />Page 30 <br />Total Fee Collected $ <br />By <br />