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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° 1057 <br />Jab Address <br />Legal <br />1 Descr. <br />3 4o�s' F <br />Lot No. J BIk. <br />/L( L ct .J <br />Bldg. Permit No. <br />Tract <br />See Attached Sheet <br />Owner <br />2 <br />Mailing Address <br />Zip <br />Phone <br />Applicant Mailing Address S`.} f3JZip Phone <br />3 S+ocl<AteSS Roper7'P, /90 Ry,tKOn At fl7/) (6/,0 4-/ YFV- /21'6 <br />rchitect or Eng. as MailingAddress/ Zip Phone <br />4 �G C 7oti; ,2031///c 1. ita.Aa ElsGi� < #z8o Ss1/7 <br />/ � Li ((�,lz) 990 -92.6g <br />f/)r� N. <br />iiaa� M <br />Contractor Mailing Address <br />5 Sfock,vess erop.ert/,!S <br />Zip Phone <br />Purpose of Fill or Excavating / �" <br />6 f-, y/ 4414 1 h 614 L0 -h;vr t prep. S etc + o b'froitAc Proper Orat:s+ac0 e <br />Type and Amount of Fill or Excavating <br />' Sa.t,�� cIa.y NttX Co».pac'ab1eF/'// <br />a prey. J, 000 cy <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 Contractor or Autho med Agent <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 hr1 <br />3. Inspections for which no fee is specifically indicated$30.00 per hr1 <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 />i and fringe benefits of the employees involved. <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 />Page 34a <br />Permit Validation <br />MO Cash <br />Total Fee Collected $ !- (. (r2 <br />By - <br />