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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 on /y. <br />N° 1040 <br />Job fin, /y1 .1 �'/'f <br />O 0` )-)Q *Ie/tr l <br />Legal <br />1 Descr. <br />Lot No. <br />Bldg. Permit No. <br />Blk, Tract <br />See Attached Sheet <br />Owner Mailing Addre Zip <br />2 C LEDHir TiJ C,... A 0. I II-en 7rAM Eitichl y Sal' <br />Zip <br />s—s-// 2 <br />Architect or Eng. Mailing Address Zip <br />(AS-c-,. 0 e9 7 /6-)F(uun- LA : Cc/ 0% <br />Zip Phone <br />Applicant Mailing Address <br />3T v1 67l{ - _ . (o 2yS4 frit eNt:ful <br />41-"b actor <br />5 <br />Mailing Address <br />Phhf ))© <br />Phone <br />4'6'l- toe" 0 <br />Phone 2 S"ts" <br />Purpwse of Fill or Excavating <br />6 *?- Irkffio t ed ,r'a -' Pik ni- apt/. <br />Type and Amount of Fill or Excavating <br />7 C'.1 -h9 -firLL 4— /0&&c /Pr <br />8 <br />Special Conditions <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 />Signature of Owner (If Ownej.'Contractor) <br />50 cubic yards or less $15.00 <br />51 to 100 cubic yards 2290 <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 hri <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 hri <br />(minimum charge —one-half hour) <br />for 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 />(Date) <br />r -2.C, 7Z <br />(Date) <br />Building Official <br />(Date) <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS IS YOUR PERMIT <br />WHITE — Inspector <br />CANA RY— Customer <br />PINK— Office <br />Page 5 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />