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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 />'M 1064 <br />Job Address <br />L Lc_ BLA. i... to Lc, (a.-.O3 ti <br />Bldg. Permit No. <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />Legal ]Lot No. 't �/I Blk.(� 1 ( Tract + 17 I <br />Descr. 1.49-6 1 ), Q...,&gi I )oJ'(...4rc- s \lM v.. k a �C., 0.(.��j.-ko -t <br />Owners / Mailing Address 1 J�Zip ` Phone <br />V\CkirV YIc�lbw- "2.� -r <br />Mailing 4n)/.c� �` +�1 L4-}1.c..ih- v.`1t1 6'�gi`"1 -6s1� <br />Applicant (J Mailing Address Zip Phone <br />50.w...f i <br />See Attached Sheet <br />Architect or Eng. <br />Contracto <br />Mailing Address <br />Sc>. -..P <br />Zip Phone <br />Mailing Address <br />SG <br />Zip Phone <br />Purpose of Fill or Excavating <br />yr <br />7 <br />Type and Amount of Fill or xcava ing l <br />cr <br />�.h00 - soc cu <br />Special Conditions <br />PERMIT FEE $ 9(Q t <br />00 <br />SU 4RGE. r 50 <br />r—�u NOTICE <br />This permit becomes nul 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 $16.00 <br />51 to 100 cubic yards 22.60 <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 hrt <br />(minimum charge —two hours) <br />2. Reinspection fees assessed under provisions of <br />Section 305 (g) $30.00 per hrt <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 />and fringe benefits of the employees involved. <br />Signature of Contractor or Authorized Agent <br />qfisA <br />4 <br />Signature of Owner (If Owner <br />(Date) <br />Sr <br />ntractor) <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 />Permit Validation Ck MO Cash <br />Total Fee Collected $ <br />By <br />