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<br />ABOVEGROUND TANK <br />~ZTY fP T_. <br /> <br />2.. 000 (,A G,.. V vi <br />HCIUZClNTN. QIt 1IDtTIc-. .....-r. <br /> <br /> <br />~/~TlQI ~IOIII. <br />" «~)¡VFoe.t::..!E() Cc."C/I.~-¡~ <br /> <br />"IV 2CJrI'1'N- <br /> <br /> <br />.US. ..... J.. <br />2'1 0' <br />ðc>'t. <br /> <br />~f ~~ VDIT-fIIIIIIQI:. <br /> <br />oaR I SoN < <br /> <br /> <br />ÞM~ fP M TWR rtawtDCD'?1 <br />I'f~ <br /> <br />DISPENSING EQUIPMENT & PIPING: <br />"II"INII _"'111&.. "EM .101 DP\.O'JC*....... ~. <br />'1"Arple'D ~ Íit ¡gtð <br />~IIJIII PMI...UOllll. <br />l!&lf ¡lllvb R?r::::>ícc.:::no¡J <br /> <br /> <br />DPLO'ZON........ ..JTCH'?I <br /> <br />/65 <br /> <br />ÞZ.TNCa ,..... DJ~VIII TO ~'T UNE? <br /> <br />DZeTNC& ..... DZ~INII TO alll.DrMMI"? <br /> <br />PERMIT FEE CALCULATION: <br />TANK REMOVAL: <br />1. Fair market value of removal $ <br />la. Permit fee (based on current <br /> <br />-- <br /> <br />~ <br /> <br />~ <br />Building Code) <br /> <br />$ <br />$ <br /> <br />2. State surcharge (.0005 times value of '1 above) <br /> <br />- <br /> <br />3. Total permit fee for removal {add~a a 2)~60 $ <br />\; t 'jJ>' _ <? <br />TANK INSTALLATION: -}¡ 1/'r~ C<~¡v'< l"" r <br />1. Fair market value of installation $ ~ A~V~¥~~ <br />la. Permit fee (based on current BUilding Code) $ <br /> <br />lb. Plan check fee (.65 times permit fee in la above) <br /> <br />2. State surcharge (.0005 times value of #1 above) <br /> <br />$-- <br /> <br />3. Total permit fee for installation (add la. lb, and 2)$ <br /> <br />INFORMATION: <br /> <br />The undersigned agrees to perform this job in accordance with the above <br />information, attached plans and specifications, and the applicable <br />provisions of the MN Uniform Fire Code and Roseville Municipal- Ordinance. <br /> <br />For applications involving the installation of tanks and/or dispensing <br />equipment. the applicant agrees to submit two (2) copies of the site plan <br />for review. The site plan will show the proposed installation(s) and their <br />locations relative to property 11nes. roads, buildings, underground pits, <br />and other tanks. <br /> <br />The applicant further agrees to notify the eville Fire Prevention Bureau <br />to schedule an inspection at least four ( ~~rs prior to the removal or <br />installation of any tank or related equi ',j ~/ <br /> <br /> <br /> <br /> <br />ß_______________________ <br />Applicant signature <br />