LAND ALT 09.03�M
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Receipt #
Fee: $ &
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APPLICANT
CITY OF FRIDLEY
LAND ALTERATION PERNUT
e,ld5-CAI Tel. # 716 U
Effective November 3, 2000
Address s
PROPERTY OWNERS
NAME Tel. # /0
Address aw
NAME Tel. #
Address
LEGAL DESCRIPTION OF PROPERTY
Lot. Block Addition 1&4-h4A
Address: -1 1 NE'
DESCRIPTION OF LAND ALTERATION
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Value of Work: $ �t Date: Completion Date.
Source and Composition of Fill:f gz,
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ATTACHMENTS
ATTACHMENTS TO APPLICATION
The following plans, drawings, calculations, bonds and/or statements may be required by the Public Works
Department:
] Half -section map or sketch of property showing all adjacent property indicating the existing buildings and/or
structures. f
'F^ ,
[ ]
Grading "p`1an showing existmg d proposed finished contours and evaluations.
[ ] Drainage plan showing existing and proposed drainage structures, stabilization walls, retaining walls, cribbing,
dams, or other protective items.
] Calculations for and approximate quantities of excavation d/or fill required. yofvl
[ ] Signed statement fro Yn the property owner accepting responsibility 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.
[ ] Rice Creek Watershed District Approval.
[ ] Soil Borings
[ ] Other
STIPULATIONS
READ BEFORE SIGNING APPLICATION
A surety bond or certified check in the amount of $ (5% of value of work to be completed) must
be submitted after approval of application and prior to any work commencing. This bond or check is to ensure
satisfactory performance and compliance with the below stated stipulations. The 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 the City.
2. All access and street frontage of the land alteration site must be controlled by a fence, a minimum of four (4)
feet in height. All entrances must have gates that are capable of being locked.
3. Only rock, sand, gravel, dirt, or similar natural earth fill is permitted. No concrete, asphalt, or demolition
wastes will be permitted as fill unless a demolition landfill permit is first obtained from Anoka County.
4. 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.
Stipulations Continued
5. Any explosives used must be done so in accordance with Chapter 212, subsections 212.07.5A, .5B, .5C, .5D,
and .5F. 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 year, the site is to be
left in a neat and orderly condition, with maximum slopes of 2:1 with no overhang or vertical banks and with
a level bottom.
7. On the Friday of each work week, or when required by the City, material from this operation that is found to
exist en City streets shall be cleaned to the City's satisfaction by the applicant.
8. 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 of this 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.
Date:
Applicant's Signature
Date:
Property Owner's Signature
Property Owner's Signature
Date:
FOR CITY USE ONLY
Recommended for Approval By: ` Date: lq'�/�
Approved By: Date:
PERAUT EXPIRATION DATE:
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LAND ALTERATION PLAN -CHECKING FEES
50 Cubic Yards or Less ....................................................... No Fee
51 to 100 Cubic Yards ....................................................... $ 23.50
101 to 1,000 Cubic Yards ..................................................... $ 35.00
1,001 to 10,000 Cubic Yards .................................................. $ 49.25
10,001 to 100,000 Cubic Yards ................................................. $ 49.25
for the first 10,000 cubic yards plus $24.50 for
each additional 10,000 Cubic Yards or fraction
thereof.
100,001 to 200,000 Cubic Yards ............................................... $269.75
for the first 100,000 cubic yards plus $13.25 for
each additional 10,000 cubic yards or fraction
thereof
200,001 Cubic Yards or More .................................................. $402.25
for the first 200,000 cubic yards plus $7.25 for
each additional 10,000 cubic yards or fraction
thereof
LAND ALTERATION GRADING PERMIT FEES
50 Cubic Yards or Less ....................................................... $ 40.00
51 to 100 Cubic Yards ........................................................ $ 47.50
101 to 1,000 Cubic Yards ..................................................... $ 47.50
for the first 100 cubic yards plus $10.50 for
each additional 100 cubic yards or fraction
thereof.
1,001 to 10,000 Cubic Yards ................................................... $167.00
for the first 1,000 cubic yards plus $9.00 for
each additional 1,000 cubic yards or fraction
thereof
10,001 to 100,000 Cubic Yards ................................................. $273.00
for the first 10,000 cubic yards plus $40.50 for
each additional 10,000 Cubic Yards or fraction
thereof.
100,001 Cubic Yards or more .................................................. $662.50
for the first 100,000 cubic yards plus $22.50 for
each additional 10,000 cubic yards or fraction
thereof.
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C11YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
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