AF-LA - 36440w
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Receipt #
Fee: $�`- ���
APPLICANT
Address i s
NAME _
Address
NAME _
Address
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CITY OF FRIDLEY
LAND ALTERATION PERMIT
, Tel. #�i�3J �32— 6 I ZS
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PROPERTY OWNERS
Tel. #�� (m� �-132 - 6 � Z�'
Tel. #
LEGAL DESCRIPTION OF PROPERTY
Lot T Block �.. Addition �� � 5� �-N C� S t� /�� 1��C3n
Address: /S .�� �e�-�Z. %�a�
DESCRIPTION OF LAND ALTERATION
Value of Work: $%,��_ Starting Date:
Source and Composition of Fill: 0. Y� L��
Completion Date: �a � � Z�d9
PURPOSE OF LAND ALTERATION
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Stipulations Continued
Any explosives used must be done so in accordance with Chapter 212, subsections 212.07.SA, .SB, .SC, .SD,
and .SF. of the Fridley City Code and any other applicable standards, e.g. Federal, State, Industrial, etc.
6. At the end of each season's operations and no later than the last day of December each yeaz, the site is to be
left in a neat and orderly condition, with maacimum slopes of 2:1 with no overhang or vertical banks and with a
level bottom.
7.
8.
On the Friday of each work week, or when required by the City, material from this operation that is found to
exist on City streets shall be cleaned to the City's satisfaction by the applicant.
Upon completion of land alteration operations, the land must be left according to the plans and contours
submitted with this application and planted with suitable vegetation to prevent erosion.
9. Upon completion of land alteration operations or expiration ofthis permit, an inspection will be made by the
City of the premises and adjoining streets. Any damage found to have been caused by these operations will be
corrected by the applicant upon notification by the City.
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Applicant's Signature
Property Owner's Signature
Property Owner's Signature
Date: �0 Z ,��
Date: ro� Z..� �O �
Date:
FOR CITY USE ONLY
Recommended for Appro al B• Date: �`
Approved By: Date:
PERNIIT EXPIRATION DATE: I D