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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? 1059 -- <br />Job Address <br />Bldg. Permit No. <br />Legal <br />1 Descr, <br />Lot No. Blk. Tract <br />O'7 -2 1- Z2--/4Z -cotC <br />Mailing Address <br />Owner <br />2 7i / Gtc <br />Applicant <br />3 4:4 m G. <br />See Attached Sheet <br />/5' 6. <br />Mailing Address <br />Zip Phone <br />Zip Phone <br />Architect or Eng. Mailing Address <br />4 <br />Zip Phone <br />Contractor (— Mailing Address <br />5 r t S ( ri '1, w <br />//r c •� <br />Purposof�of Fill or Excavating � / <br />6 A / / %,J Wil /f <br />Zip Phone <br />44%4 a •-• rea Cii ./ — 7 /rrrj,r... fa. /' 'G 1/7 <br />,oc vn c e r. / /� r.r rrn c.< <br />Type and Amount of Fill or Excavating <br />7 <br />7 <br />Special Conditions // /f <br />6 C 4 w n_./{ 0,17 a7✓ //. jeh <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 100000 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 (g) <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 />L� �vLGr�J• � •ice <br />Signature of Owner Of wner Contracto <br />(Date) <br />r -zY <br />(Date) <br />Building Official <br />(Date) <br />$30.00 per hri <br />$30.00 per hrt <br />$30.00 per hri <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 10 <br />Permit Validation Ck MO Cash <br />3�= <br />Total Fee Collected $ <br />By T.eh< <br />