Fillmore CountyFill Permit Application

It is advisable that all applicants contact the Zoning Office prior to filling out the application to make sure that this proposed project is feasible. It is imperative that all instructions and regulations be read carefully before submitting this application.

Names of all Landowners: ______Phone #: ______

______Phone #: ______

______Phone #: ______

Address: ______

CityState Zip: ______

Date: ______Name of Township or City: ______

Parcel #: ______Legal Description from deed, abstract or Recorders Office:

______

Section: ______Township: ______Range: ______

Have you started work on this project? Yes: ______No: ______

Proposed Project: ______

(New home, addition, etc)

Permit # ______

Cubic Yards of Dirt to be Moved ______Origin of Fill Material ______

NO WORK MAY BEGIN UNTIL A PERMIT IS OBTAINED. IF WORK HAS BEGUN ON THE PROJECT BEFORE A PERMIT IS ISSUED, A $250.00 LATE FEE MUST BE PAID IN ADDITION TO THE PERMIT FEE.

LATE FEE ______($250.00)

TOTAL FEE ______(NO REFUNDS)

In the space provided below, draw and label a diagram as close to scale as possible of your project to include the following:

  1. Setback from center of a public road and setback from property lines.
  2. Site where fill will be place in or removed from Shoreland.
  3. Setback from a bluff, a feedlot or rock quarry.
  4. Show other structures in the vicinity.

SITE INSPECTIONS ARE REQUIRED FOR ALL NEW DWELLINGS: The footings must be dug and inspected before the actual construction of the dwelling may begin.

I hereby certify that the information contained herein is correct and agree to do the proposed work in accordance with the provisions of the Ordinances of Fillmore County and the Statutes of the State of Minnesota.

Signatures of All Landowners

______

Name Date

______

Name Date

______

Name Date

______

Township Officer or City Official Date

Send all correspondence to:

Fillmore County Zoning

P.O. Box 665

Preston, MN 55965

(507) 765-3325