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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 />N9 1048 <br />Job Address <br />.2 75 c /t /o'e/ 7 <br />Lot No. <br />Descr. !!♦_tip/ gi �7 <br />Legal <br />1 <br />Bldg. Permit No. <br />Blk, <br />e tee <br />Tract <br />C5.7- — , q _ , _ 3 /_ cc .t &— Re Attached Sheet <br />Owner <br />2 J-041 S i 0�9 <br />Applicant <br />3 Sr7 N1-{ <br />Architect or Eng. Mailing Address <br />4 <br />X <br />Mailing Address Zip <br />7JZ' /Yee /Q s7 /a /get 137/7 NSK- �b'f5' <br />Zip Phone <br />Mailing Address <br />Phone <br />Zip Phone <br />Contractor }— Mailing Address <br />5 IfCAISs 5- V/a4/n4cni ,Scrfn.{ <br />Purpose of Fill or Excavating <br />Zip Phone <br />6 ,L::Y // arc/ 4r,,e7 )%/ 40r.3 e fro Cie c <br />Type and Amount of Fill or Excavating �/ <br />7 f�9D 'Ci!S O i� 4i/i ?CV/ <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 />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 (g) $30.00 per hri <br />3. Inspections for which no fee is specifically indicated $30.00 per hr1 <br />(minimum charge —one -half hour) <br />1or the total hourly cost to the jurisdiction, whichever is the greatest. <br />This cost shall include supervision, overhead, equipment, hourly wages <br />and fringe benefits of the employees involved. <br />Signa Contractor or Atithoriz?d Agent <br />b <br />$ igrf4ture of Owner If er Contractor <br />( ) <br />(Date) <br />/Pict?r -73 <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 2 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />