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2. PRO�'Y Q�IAiIIttS) :
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street Aaaress street Aaaress
City, State Zip Code City, State Zip Code
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Offioe Phone eaae Phore Offioe Phone Hame Phone
3. LBGAL D�SQtIP'P�I OF P�ERTY ZV BE ALTF�i�: �
r�.o�t / z a�ock L �ract
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City State Zip Code
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F� U.vG To � EvEcaP �vt �.p✓�vG s�%� .
5. PtAtP06E OF I.Ai�ID ALTF�iAT��i:
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6. VALUE OF W�tR ZO BE PERFiOtiN�: 8 Z SO
7. sot� x� aoNaaasi�o�t oF �: s'` r wa o,p m�� s, , E
8. PRO�O�SF.D SZARTII�IG I1A�E: �LE�DO� L1ATE: ' c L �S�
� 9. ATPACHI�]'t5 tInfonaation Needed to Properly EValuate Applicatior� :
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�rie follvwing plans, drawings, calculatians, bonds and/or statenents will
be required by the Public Wocks Degart�nent.
8alf section map or sketch of property shawing all adjacent property
indicating the exisiting buildinc�s anc]!or structure8.
Grading plan showing exisiting and proposed finished contours and
evaluations.
Drainage plan showing exisiting and proposed drainage structures,
stabilization walls, retaining walls, cribbing, daans, or other protective
items.
_ Calculati�s for and approximate quantities of excavation and/or f ill
required.
Sic,�ed statenent fram the pcoperty vwrer acoepking responsibilty for
the operation and granting penaission for Iand alteration/mining
operation.
_ Stateaent to be attac�ied to deed advising of potential need for soil
tests prior to any o�nstruction on lots where additional fill material
has been plaoed.
_ Rioe Creek Watershed District Appraval (If Applicable)
_ Soil Borings (if require�
_ Other
10. STIPUI.ATDQ�iS - RF�AD BEEORE SI(�iII�]G APPLICA�DQ�Is
a. A surety bor�d or oeritified check in the amount of S
(5� of value of �,rork to be oompleted) must be submitted after
approval of application and prior to any work commencing. This
bond or check is to ensure satisfactory perf ormance and
oomp2ianoe with the below stated stipul.ations. �e surety bond
or check shall be kept active until the completion of work
and/or expiration of permit and c,�n only be released iyy written
notification of the City after a satisfactory final inspection
has be� perfornied by Cfty foroes.
b. All acoess anc] street frontage of the land alteration site must
be oontrolled by a fenoe, a mininKm of fau (4) feet in height.
A11 entrances must have qates that are capable of being locked.
c. Oril.y rock. sand, gravel, dirt, ac similar natural earth f ill is
Penaittec7• No ooncret�e, asphalt, o� clesnolition wastes will be
permitted as fill �� a da�alition landfill permit is first
obta�ined fran Aroka Co�ty.
d. Operations shall be limited to daylight hours and shall not
interfere with �e health and safety of surroundinq residents
and the pcemises shall be maintained at all times so as not to
create a nuisanoe.
e. �ny explosives used must be �br�e so in acooFClance with Chapter
212.3, paraqraphs d, e, f, g, of �e Fridley City Code and any
other applic�ble standard e.g. Federal, State. Industrial, etc.
f. At the en� oi each season's operations and no later than the
last day oi Deoe�nber each year, the site is to be left in a neat
and orderly condition, wfth maximum slo�es of 2:1 vith no
averhang or vertioal banks and with a level bottam.
g. On the Friday of ench wock w�eek, or when required by the City.
�materiel from this operation that is found to euist on City
atreets shall be cleaned to the City's satisfaction by the
appliaant.
h. Upon oou�letion of land alteration oQerati�s, the land must be
left a000rding to the plans and contours submitted with this
application and planted with suitable vegetation to prevent
erosion.
i. Upon vampletion o� land alteration aperations or expiration of
this permit, an inspection by the City will be made of the
prenises and adjoining streets. Any cYaanage found to have been
caused by these aperations will be corrected by the applicant
upon notifi�tion �e Ci
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Applicant's Sicg�ature: Date:
Property Owner's Sic�r�ature Date:
Reoo�miended For Appraval : Drate:
AP�RWID BY: Date: 7- Z L- B¢
PF�iNlIT E�IRATIDN DA'PE:
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5�- (�bic yards or less . . . . . . . . . . . . . . . . . . . . . . No i�ee
51 to 100 wbic yards . . . . . . . . . . . . . . . . . . . . . . . 510.00
101 to 1000 c�bic yards . . . . . . . . . . . . . . . . . . . . . . 15.00
1001 to 10,000 wbic yards . . . . . . . . . . . . . . . . . . . . 20.00
10,001 to 100,000 cubic yards - 520.00 for the first 10,000 cubic yarc3s
plus 510.00 for each additional 10,000 cubic yards or fraction thereof.
100,001 to 200,000 cubic yarcis - 5110.00 for the first 100,000 cubic
yards plus 56.00 for each additional 10,000 cubic yards or fraction
thereof .
200,001 cubic yards or more - 5170.00 for the first 200,000 cubic yards
plus 53.00 for each additional 10,000 cubic yards or fraction thereof.
,��.�_ �ii yi�;, r• � �,_ ;:n;, 4• s:�.
50 Wbic yards or less . . . . . . . . . . . . . . . . . . . . . . 510.00
51 to 100 cubic yards . . . . . . . . . . . . . . . . . . . . . . . 515.00
101 to 1000 cubic yards - 515.00 for the first 100 a�bic yards plus 57.00
for each additional 100 cubic yards or fraction thereof.
1001 to 10,000 cubic yards - 578.00 for the first 1,000 cubic yarc7s plus
86.00 for each ack3itional 1,000 cubic yarc3s or fraction thereof .
10,001 to 100,000 wbic yarc7s - 5132.00 for the first 10,000 cubic yarcis
plus 527.00 for eac� additional 10,000 cubic yards or fraction thereof.
100r001 cubic yards or more - 5375.00 for the first 100,000 cubic yards
plus 515.00 for ea� additional 10,000 cubic yards or fraction thereof.
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� a�iC y�C� �r IE�$B • • • • • • • • • • • • • • • r • • • • • • NO �''E�
sl �o loo `�i� �r� R E C E I P T
101 to 1000 cubic y ��� y���
1001 to 10,000 cubi � �"' //�
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io,00i to ioo,000 c � �
plus 510.00 for eac
100�001 to 200�000 �31 University Ave. N.E.
yards plus 56.00 f Fndiey, Minnesota 55432 Tel. 571•3450
thereof .
200,001 cubic yarde
plus 53.00 for eac�
I.AI�ID Ai��IIiAT�ON Qi�
50 C�bic yards or ]
51 to 100 cubic ya�
101 to 1000 cubic ;
for eadi addi.tf ona;
1001 to 10,000 cub:
56.00 for eaci� ac3d
10,001 to 100,000 �
plus 527.00 for ea
100,001 cubic yard
plus 815.00 for ea
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N�. 137�1
ALATIAKIT� MOOR[ �VfINf/f IORMf� INC. - N�N��10�1y06