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A U G— 2— 9 3 PI O N <br />9 : 2 4 0 <br />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 />r <br />P. ci y <br />N? 1049 <br />Job Address <br />31000 LP; /%Cr; <br />57-/4u/ <br />0idg. Permit No <br />Legal <br />1 Cesar. <br />Lot No. <br />Elk. Trott <br />See Attached Sheet <br />Owner <br />2 ■% h,j C Sc.,/ / , <br />Applicant <br />3 c /7'f1H <br />Architect or Eng. <br />4 <br />Mailing Address Zip <br />tMc 4,4110 r>= / 0 5--sze <br />Melling Address Zip <br />Phone <br />Veil' z 55 <br />Phone <br />Mailing Address Zip <br />Phone <br />�qContractor Melling Address r <br />5 Kul y xcn+ri r'b,n: Y (�rt1Ta/ L. e(, d "/ec c w94 <br />Pur se of F111 or Excevaf o9 <br />6 <br />ZIP <br />Phone <br />7 <br />Typo and Amount of Fill or Excavating <br />Spacial Conditions <br />PERMIT FEE $ <br />NOTICE <br />This permit becomes null and void if filling or grading authorized I* not <br />completed within 100 days, or if filling or grading is suspended or <br />abandoned for a period of 180 days it any time after work is com- <br />menced, Any work not completed within 180 days requires s new permit, <br />I hereby certify that 1 have read end examined this application and <br />know the tame to be true and correct. All provisions of laws end <br />ordinances governing this type of work will be complied with whether <br />specified herein or not, The grsnting of a permit doe' not presume to <br />Om authority to violet* or cancel the provisions of any other state or <br />lac& law regulating filling or grading, <br />5igngture of Contractor or Authorized Agent <br />cde <br />nature of Owner Ill Owner CO rector) <br />Building Official <br />50 eubio yards or law $16.00 <br />51 to 100 cubic yards 22.50 <br />101 10 1,000 cubic yards — 522.50 for the first 100 cubic yards, <br />Plus 510.50 for yeah additional 100 cubic yards or fraction thereof. <br />1,001 to 10,000 cubic yards —.5117.00 for the first 1,000 cubic yards. <br />Pius 59.03 for each additional 1000 cubic yards or fraction thereof, <br />10,001 to 100,000 cubic yards — S198.00 for the first 10,000 cubic <br />yards, plus $40,50 for each additional 10,000 cubic yards or traction <br />thereof, <br />100,001 cubic yards or more — 5552.50 for the first 100,000 cubic <br />yards, plus 522.60 for each additional 10,000 cubic yards or fraction <br />thereof, <br />Other Inspections and Pees; <br />1. Inspections outside of normal business hours <br />(minimum charge —two hours) <br />2. Reinspectlon fees assessed under provisional <br />Section 306 (0) <br />3. inspections for which no fee Is specifically indicated <br />(minimum charge — one -half hour) <br />1or the total hourly cost to the Jurlsdict ion, whichever is <br />This cost shall include supervision, overhead, equipment, <br />and fringe benefits of the employees involved, <br />520.00 per hr.! <br />530.00 per hri <br />330.00 per hrt <br />the greatest, <br />hourly wages <br />Post•It" brand fax transmittal memo 7671 I a of pages • a <br />TO �Sa� <br />C <br />Co. <br />Dept, <br />Fax e <br />From <br />41,4` <br />Co. <br />Phonon <br />Fax it <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) THIS 1S YOUR PERMIT <br />WHITE — Inspector <br />CANARY — Customer <br />PINK — Office <br />Page 67 <br />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />ay <br />