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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° 1033 <br />Job Address <br />7.7`7 LAkE5 /PE cot) A?r <br />Bldg. Permit No. <br />Legal <br />1 Descr. <br />Lot No, <br />/3 <br />Blk. <br />Z <br />Tract <br />Z3LOMav/STs GA,Y .s/v� <br />o0 3�'�13 <br />See Attached Sheet <br />Owner Mailing Address Sri-346,./z_ Zip <br />2 a7Zisf4 /EY4121 '/4 Gh/112Cc 7078 REAvE y /-/r Cs -/o(�, <br />Phone • <br />776 -bS-E <br />Applicant Mailing Address Zip <br />3 .SAM F <br />Phone <br />Architect or Eng. Zip" /i /NGS Mailing Address % 31 — ,4// Zip <br />4 A 12,63 7-E5 T DA'/r ivy ycoc) /.Cg�v 1r / ?vc DR. 5—s- 2 z <br />Contractor Mailing Address G //7Ag C44-140.1 Zip <br />5 /=/i4 TTAtd,✓c Exc4 -4r 4 ?E‘ Sr 5'-1S i/7 <br />Phone <br />t /.S /v9/3 <br />Phone <br />y8 %G) yy <br />Purpose of Fill or Excavating <br />6 c5;9/2._ Ga' /h.Gi /aN /cc7W /cc c,"--a+/-70,4/ d/" /✓�LJ 44"r,e <br />Type and Amount of Fill or Excavating / / <br />7 l/ e.'vNOVI �- Siry, _,10 z/4 „fry /906,761s �-qt..j 2)S ✓ff7 Y-Ce.n/!.<_7 /h ./J c,J v will j r nviv <br />c /GL /co/ 7' 1- T- Yr ✓rnr)- /&W 4✓12.v.4y- <br />8 <br />Special Conditions <br />4r240Arno /74/<.; •? /ccie4?2-- <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 (9) <br />3. Inspections for which no fee is specifically indicated <br />(minimum charge —one -half hour) <br />for the total hourly cost to the jurisdiction, whichever is <br />This cost shall include supervision, overhead, equipment, <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 />$30.00 per hr1 <br />$30.00 per hr1 <br />$30.00 per hr1 <br />the greatest. <br />hourly wages <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE — Inspector <br />CANARY— Customer <br />PINK — Office <br />Page 5 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />