LAND ALT 12.82t
�l
MIT OF PRIMAr
1. APPLIt�IITP:
J , A . Miam icytLsb 4A- sserc,Aits
Efte
Address
441-oi�,n
Telephone amftr
T. p�ao owxt ts) :
.��. M /aT T � S � ►�G
Nme
)►CStio z!o`7 0my 41c: k)-)C—
Street
reet Address
V�) un wcE �s4-33
City, state Zip Code
7 &6-43L)o
Office Phone some phone
3C REICEzpr #
nA� / 2-//382
Street Address
City, State Zip Code
Office Phone Name Phone
3. IAGAL DESMIPTION OF PROPERTY 70 BE AMPM:
Lotti 2 7, Block S Tract I�-y�� v EaJt tc E.►TS
f r' J e Aj t tEl"i 7ky--A-A-els
F��U��y•-
city State Zip Code
4. DMOUPTION OF LAND ALTEPAnON OPERATM �
G VAZ Z� titAT��LIA L ,
S. pwtPOrSE OF LAND ALTm►Tmg 1,, E E: 'Jk—z- L rT'�
6. VALUE OF WOM TO BE PfliPCRMEO: i
7. sm= AMID aw06nm OF pm, Di R' —i Fp-.cpi N-,vvJE1cJjb
t7p1T100 K)AI-L)"L SAO
LA, -1 � �O+JD
•. pROPO�SED srARTn�c tm: 1 `-/ 2- voh�LETmN nm: 82
r
9. AM CHMEMS (Information Needed to Properly Bvaluate Application) :
the following plans, drawings, calculations, bonds and/or statements will
be required by the Public Works Department.
•� _ Half section may, or sketch of property showing all adjacent property
Indicating the exisiting buildings and/or structures.
_ Grading plan showing exisiting and proposed finished contours and
evaluations.
_. Drainage plan showing exisiting and proposed drainage structures,
stabilization walls, retaining walls, cribbing, dams, at other protective
Item.
_ Calculations for and approximate quantities of excavation and/or fill
required.
r _ Sided statement from the property owner accepting responsibilty for
the operation and granting permission for land alteration/mining
operation.
_ Statement to be attached to deed advising of potential need for soil
tests prior to any construction on lots where additional fill material
has been placed.
_ Rioe Creek Watershed District Approval (If Applicable)
_ Soil Borings (if required)
_ Other
10. STIPULPMCKS - READ BEFORE SIGMG APPLICATEMS
a. A surety bond or ceritified check in the amount of i
(St of value of work to be oaVleted) must be submitted after
approval of application and prior to any work commencing. This
bond or check is to ensure satisfactory performance and
oompliance with the below stated stipulations. %fie surety bond
or check shall be kept active until the completion of work
and/or expiration of permit and can only be released by written
notification of the City after a satisfactory final inspection
has been performed by City forces.
b. All access and street frontage of the laud alteration site must
be controlled by a fencer a minimum of four (4) feet in height.
All entrances must have gates that are capable of being locked.
c. Only rock, sand, gravel, dirt, or similar natural earth fill is
permitted. No concrete, asphalt, or demolition wastes will be
permitted as fill a demolition landfill permit is first
obtained from Anoka County.
d. Operations shall be limited to daylight hours and shall not
Interfere with the health and safety of surrounding residents
and the premises shall be maintained at all times so as not to
create a nuisance.
e. Any explosives used must be done so in accordance with Chapter
21 .3, paragraphs d, or f, g, sof the Fridley City Code and any
other applicable standard e.g. Federal, State, Industrial, etc.
f. At the and of each season's operations and no later than the
last day of December each year, the site is to be left in a neat
and orderly condition, with maximum slopes of 2sl with no
overhang or vertical banks and with a level bottom.
q. 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.
h. Upon oampletion 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.
i. Upon completion of land alteration operations or expiration of
is permit, an inspection by the City will be made 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.
7
AWlicant's Signatur L Dates % Z 13 - Z
Property Owner's Signa e Date: J4
Reoonerended For Approval By: Dates
APPFOM BY: ic� Dates 2—
PERMIT
PERMIT EXPIRATION DATE:
� � T
1. >� 1• ..IJ• 11 =•J.
50 Cubic yards or less ......................Ido Fee
51 to 100 cubic yards ....................... $10.00
101 to 1000 cubic yards .....................
1001 to 10,000 cubic yards .................... 20.00
10,001 to 100,000 cubic yards - $20.00 for the first 10,000 cubic yards
plus $10.00 for each additional 10,000 cubic yards or fraction thereof.
100,001 to 200,000 cubic yards- $110.00 for the first 100,000 cubic
yards plus $6.00 for each additional 10,000 cubic Yards or fraction
thereof.
200,001 cubic yards or more - $170.00 for the first 200,000 cubic yards
plus $3.00 for each additional 10,000 cubic yards or fraction thereof.
1.Ny. 0 • ! 1
50 Cubic yards or less . . . . . . . . . . . . . . . . . . . . . . $10.00
51 to 100 cubic yards.... ................... $15.00
101 to 1000 cubic yards - $15.00 for the first 100 cubic yards plus $7.00
for ch additional 100 cubic yards or fraction thereof.
1001 to 10,000 cubic yards - $78.00 for the first 1,000 cubic yards plus
$6.00 for each additional 1,000 cubic yards or fraction thereof.
10,001 to 100,000 cubic yards - $132.00 for the first 10,000 cubic yards
plus $27.00 for each additional 10,000 cubic yards or fraction thereof.
100,001 cubic yards or more - $375.00 for the first 100000 cubic yards
plus $15.00 for each additional 10,000 cubic yards or fraction thereof.
5/1/6/3
i od
S
9. ATVCHKMM (Information Needed to Properly D aluate Application):
`hfe follow - --a �"- 04.a*ampntz will
be require RECEIPT
•� _ Half se Sam•
inai®tine DGradin
(fit 0/
Yri dL eo/"
eNaluatiolt �
Drainal 6431 University Ave. N.E.
stabilize' Fridley, Minnesota 55432 Tel. 571-3450
Items.
= we ul RECEIVED OFrV
required. $
v _ Signet
the open
operatic ADDRESS
Sto
s yr. FOR —
has been
_ Rice
Soil FUND
CODE AMOUNT
Other G 3 0. o 0
10. STIP"
as A s
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an
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b. Al' ey I
be
Al 19 2
No. 8172
c. Or PLA?PARiT® Y.....YMIM.{/ /..M.. IWe.
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obtained from Anoka County. -
d. Operations shall be limited to daylight hours and sball not
interfere with the health and safety of surrounding residents
and the premises shall be maintained at all times so as not to
create a nuisance.