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91-072 RES . Passed and adopted by the Elk River City Council on this 2nd day of December, 1991. )! _~_/ .vo ..' h/!fJ4~ <~,/{tI .l'~ /v u-~/ . .. / /, /~.:~; James A. Tralle, Mayor . RESOLUTION 91-72 RESOLUTION FOR THE CITY OF ELK RIVER A RESOLUTION SETTING FEES WHEREAS, the City has considered the cost incurred by the City to process the various items that fees are charged for; and WHEREAS, the City has researched fees charged by other cities; and, WHEREAS, the proposed fees are consistent with the cost incurred by the City and those fees charged by other cities; and, WHEREAS, the Elk River City Council has duly considered the proposed fees. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Elk River, Minnesota that fees shall be as set forth on the attached fee schedule. ATTEST: /! . CITY OF ELK RIVER 1992 FEE SCHEDULE ~ASSESSMENT SEARCH/CERTIFICATION: BUILDING PERMITS: Industrial, commercial, multifamily residential $ 15.00/each *State permit fee (valuation based on current State of MN building valuation data) Schedule Exhibit "A" (Table 3A, 1988 U.B.C.) plus 65% plan check fee plus State Surcharge *City permit fee (valuation based on current State of MN building valuation data) Schedule Exhibit "B" plus 65% plan check fee plus State Surcharge Single Family Homes and Additions State Residential Contractor License Search $ 5.00 per permit . Miscellaneous Building Permits City permit fee Schedule Exhibit "c" plus State Surcharge *City permit fee Schedule Exhibit "D" Gas Fitting Permit Fee Gas Fitter's License $ 24.00/year Plumbing Permit Fee *City permit fee Schedule Exhibit "E" CIGARETTE: COPIES: $ $ 15.00/yearly .25/page DOCUMENTS: City Code Zoning Ordinance Subdivision Ordinance Solid Waste Ordinance Sign Ordinance Growth Management Plan With Addendurns: PUD Study ~ Park Plan Study \ " \". DOG LICENSE: $ 75.00 $ 25.00 $ 10.00 $ 10.00 $ 5.00 $ 25.00 $ 25.00 $ 25.00 $ 5.00/2 years City of Elk River Fee Schedule November 12, 1991 ~------------------------------ . ~. GARBAGE HAULER LICENSE: Page 2 *$ $ 60.00 1st Truck/ lS.00/Each Addl Truck GRADING PERMIT: *$ 2S.00 plus City Consultant fees if required to process application KENNEL LICENSE: $ 7S.00/year LIQUOR LICENSE: Club Intoxicating On Sale Intoxicating Sunday on Sale Non-Intoxicating Off Sale Non-Intoxicating On Sale Set Up Wine Temporary Non-Intoxicating Temporary Intoxicating $ 300.00/year $4,000.00/year $ 200.00/year $ 7S.00/year $ lS0.00/year Issued by State $ SOO.OO/year $ 20.00/day $ 20.00/day MAPS: ~ Large Base, Zoning or Land Use Map ( Medium Base or Zoning Map $ $ 3.00/each 2.00/each MECHANICAL AMUSEMENT: Mechanical Rides Pin Ball Games Pool Tables (Coin Operated) Video Games Juke Boxes $ $ $ $ $ 3S.00/ride 3S.00/machine 3S.00/table 35.00/game 35.00 MINERAL EXTRACTION: *$2,000.00/year PARK DEDICATION FEE: Residential Commercial Non-City Sewer City Sewer Industrial $ 350.00/dwelling unit $l,OOO.OO/per acre $1,500.00 per acre N/A $1,750.00/Year PAWN SHOPS: PINS (Plastic-Elk River): (Metal-Elk River): $ $ .35/each 1. SO/each SEPTIC INSTALLATION: ~SEPTIC REPAIR: \ '~. *$ *$ 60.00 30.00 SEWER AVAILABILITY CHARGE: (Plant replacement interceptor) $1,300.00 City of Elk River Fee Schedule November 12, 1991 ~------------------------------ SIGN PERMITS: Up to 100 square feet 101 Square feet to 300 square feet Over 300 square feet Yearly Advertising Structure (Billboard) Inspection SOLID WASTE FACILITY LICENCE: STREET DISRUPTION OR UTILITY HOOKUP PERMIT: TRANSIENT MERCHANT LICENSE: (Requires Public Hearing) FOR WATER AVAILABILITY CHARGE CONTACT ~ELK RIVER MUNICIPAL UTILITIES AT 441-2020 ! ZONING APPLICATIONS (Note: Extraordinary City Consultant time will be charged back to petitioners of all zoning requests): Administrative Subdivisions Conditional Use Permit Commercial/Industrial Residential Amendments and Renewals requiring Public Hearings Concept Review Easement Vacation Multiple Principal Buildings Nonconforming Sign Alteration ~ Ordinance Amendment Page 3 $ 30.00 $ 90.00 $ 150.00 $ 10.00 $1,000 plus Cost Incurred Reviewing license Amount of Annual Cost incurred by the City for monitoring and inspecting the facility plus administering the license *$ 25.00 $ 50.00/year *$ 150.00 plus Park Dedication if applicable *$ 200.00 $ 100.00 $ 75.00 $ 200.00 (applied to application fee if application proceeds) *$ 150.00 *$ 200.00 plus Park Dedication if applicable $ 110.00 $ 250.00 City of Elk River Fee Schedule November 12, 1991 411r----------------------------- Page 4 Plats *$ 500.00 Retainer/Application Fee plus Concept Review Fee. Actual cost incurred by the City for review of the plat plus park dedication if applicable Permitted Home Occupations *$ 15.00 Planned Unit Development (PUD) Charge for whatever zoning request is needed to review the PUD (Condi tional Use, plat, Concept Review, etc. ) Site Plan Review $ 150.00 $ 110.00 $ 250.00 $ 50.00 Variance Zone Change :. \ Other Zoning Requests (. I CITY OF ELK RIV?R EXHIBIT A FEE SCHEDULE CO~~RCIAL 'INDUSTRIAL MULTI FAMILY '.. BUILD ING PER..'1IT FEES Permit ermit Permie , I/aluation Fee Valuaeion Fee Valuaeion Fee $ 1 - 500 $ $ L3,OOl - 14.000 $ 153.00 $ 40.001 - 41.000 1$ 356.00 501 - 600 14,001 - 15.000 162.00 41,001 - 42.000 362.50 601 - 700 15.001 - 16.000 171. 00 42,001 - 43.000 369.00 701 - 800 16.001 - 17,000 180.00 43.001 - 44.000 375.50 801 - 900 17.001 - 18,000 189.00 44.001 - 45,000 382.00 901 - 1,0001 18,001 - 19,000 198.00 45,001 - 46,000 388.50 1,001 - 1,100 27.0 19,001 - 20,000 207.00 46,001 - 47.000 I 395.00 1,101 - 1,200 29.00 20,001 - 21,000 216.00 ,47,001 - 48,000 I 401.50 1,201 - 1.300/ 31.00 2 1 ,001 - 22,000 225.00' 48.001 - 49,000 I 408..00 1,301 - 1,4001 33.00 22,001 - 23.000 234.00 49,001 - 50,000, / 414.50 1 , 40 1 - 1.50dl 35.00 23.001 - 24.000 I 243.00 50.001 - 51,000 419.00 .501 - 1.600 37.00 24.001 - 25,000 I 252.00 51, 00 1 - 52,000 423.50 1,601 - 1,700 39.00 25,001 - .26,000 I 258.50 52,001 - 53,000 428.00 1. 701 - 1,8001 41 . 00 25,001 - 27,000 I 265.00 53,001 - 54,000 432.50 1. 80 1 - 1,900 43.00 2 7 , 00 1 - 28,000 I 27 L 50 54,001 - 55,000 437.00 1,901 - 2,000 45.00 28,001 - 29,000 I 278.00 55,001 - 56,000 441. 50 2,001 - 3,000 54.00 29.001 - 30,000 I 284.50 56,001 - 57,000 446.00 3.001 - 4,0001 6J.00 30,001 - 31,000 I 29LOO 57,001 - 58,000 450.50 4.001 - 5,000 3 1 , 00 1 - 32,000 297.50 58,001 - 59,000 455.00 5,001 - 6,000 J2, 001 - 33,000 304.00 59,001 - 60,000 459.50 6,001 - 7,0001 33,001 - 3t..,000 310.50 60,001 - 61,000 46t...00 7,001 - 8,000/ 3t..,OOl - 35,000 317.00 61 ,001 - 62,000 468.50 8,001 - 9,000/ 35,001 - 36,000 323.50 62,001 - 63,000 473.00 10,000/ 36,001 - 37,000 330.00 63,00L - 6t..,OOO 477.50 11 ,000 37,001 - 38,000 336.50 64,00L - 65,000 482.00 11 ,001 - 12,000/ 135.0 38,001 - 39,000 343.00 65,001 - 66,000 486.50 12.001 - L 3.000/ 144.0 39,001 - 40,000 349.50 66,00L - 67,000 49l. 00 e . (,e EXHIBIT B EFFECTIVE: 1/1/92 RESIDENTIAL BUILDING PERMIT FEES PERMIT PERMIT PERMI" VALUATION FEE VALUATION FEE VALUATION FEE $ 1 - 500 $ 14 $22,001 - 23,000 $211 $48,001 - 49,000 $378 501 - 600 16 23,001 - 24,000 220 49,001 - 50,000 384 601 - 700 18 24,001 - 25,000 228 50,001 - 51,000 391 701 - 800 20 25,001 - 26,000 237 51,001 - 52,000 395 801 - 900 22 26,001 - 27,000 243 52,001 - 53,000 399 1,001 - 2,000 24 27,001 - 28,000 249 53,001 - 54,000 403 2,001 - 3,000 43 28,001 - 29,000 255 54,001 - 55,000 407 3,001 - 4,000 52 29,001 - 30,000 261 55,001 - 56,000 412 4,001 - 5,000 60 30,001 - 31,000 267 56,001 - 57,000 416 5,001 - 6,000 68 31,001 - 32,000 273 57,001 - 58,000 420 6,001 - 7,000 77 32,001 - 33,000 279 58,001 - 59,000 424 7,001 - 8,000 85 33,001 - 34,000 285 59,001 - 60,000 428 8,001 - 9,000 94 34,001 - 35,000 291 60,001 - 61,000 433 9,001 - 10,000 102 35,001 - 36,000 297 61,001 - 62,000 437 10,001 - 11,000 111 36,001 - 37,000 303 62,001 - 63,000 441 11,001 - 12,000 119 37,001 - 38,000 311 63,001 - 64,000 445 12,001 - 13,000 127 38,001 - 39,000 317 64,001 - 65,000 449 13,001 - 14 , 000 136 39,001 - 40,000 323 65,001 - 66,000 454 14,001 - 15,000 144 40,001 - 41,000 329 66,001 - 67,000 458 15,001 - 16,.000 153 41,001 - 42,000 335 67,001 - 68,000 462 16,001 - 17,000 161 42,001 - 43,000 341 68,001 - 69,000 466 17,001 - 18,000 169 43,001 - 44,000 347 69,001 - 70,000 470 18,001 - 19,000 178 44,001 - 45,000 354 70,001 - 71,000 475 19,001 - 20,000 186 45,001 - 46,000 360 71 , 00 1 - 72,000 479 20,001 - 21,000 195 46,001 - 47,000 366 72,000 - 73,000 483 21,001 - 22,000 203 47,001 - 48,000 372 73,001 - 74,000 487 , .;:.- . RESIDENTIAL BUILDING PERMIT FEES CONTINUED .. PERMIT PERMIT VALUATION FEE VALUATION FEE 74,001 - 75,000 491 87,001 - 88.000 546 75.000 - 76,000 496 88,001 - 89,000 550 76,001 - 77, 000 500 89,001 - 90,000 554 77,001 - 78,000 504 90,001 - 91,000 559 78,001 - 79,000 508 91,001 - 92,000 563 79,000 - 80,000 512 92,001 - 93,000 567 80,001 - 81,000 517 93,001 - 94,000 571 81,001,- 82,000 521 94,001 - 95,000 575 82,001 - 83,000 525 95,001 - 96,000 580 83,001 - 84,000 529 96,001 - 97,000 584 84,000 - 85,000 533 97,001 - 98,000 588 85,001 - 86,000 538 98,001 - 99,000 592 86,001 - 87,000 542 99,001 -100,000 596 100,001 -101,000 601 . EXHIBIT C . CITY OF ELK RIVER MISCELLANEOUS PERMIT FEES Decks $35.00 plus State Surcharge Fence~ Under 6 feet no charge/over 6 feet $15.00 plus State Surcharge Fireplaces and Wood Stoves. $20.00 plus State Surcharge - $15.00 plus State Surcharge for a burning appliance installed into an existing chimney. Gar~s & Basement Finish $45.00 plus State Surcharge One Story Detached Accessory St~uctures !4It $35.00 plus State Surcharge Be-RQ.Q! $25.00 plus State Surcharge Sw imm jJ)_9-.J'oo L~ $35.00 plus State Surcharge 3 Season Porche~ Exhibit B Movinq Houses $150.00 plus State Surcharge ,. \ . . ie ~.X.I:IllU_'LR ~ITY OF EL~-BIVER G.~L.f~'t.T..1NG PER~JJ'_J..:[E~_ r:F;..ES _R..~QJJI~_tJ) The Chief Building InspecLor. before issuing any permit for the installation of any gas plp.1.ng, or gas fixtures, or device shall require the payment by the applicant for such permit of fees in the amount herein. MINIJ1PM Fj:.~ In no case shall the fee charged for any permit issued by the Chief Building Inspector be less than $18.00. ~b..S__P lE.iN:.Q For any permit for installation of gas piping, not exceeding two (2) inches in diameter and not exceeding three (3) openings, the fee shall be Six Dollars and Twenty-five Cents ($6.25) and for the piping for each additional opening provided, Two Dollars ($2.00) shall be added to such permit fee. For any permit for installing gas piping exceeding two ( 2 ) inches in diameter and not exceeding three (3) openings, the fee shall be Twelve Dollars ($12.00) and for the piping for each additional opening provided, T'N'O Dollars and Fifty Cents ($2.50) shall be added to such permit fee. A gas piping permit will be required for connection to any gas-burning device, except if the appliance being connected is a replacement of an original appliance of the same type. Where any such permit is issued for both gas piping and plumbing, the fee for such permit shall be equal to the combined fees for each of said classes of work or installation. GAS~1'OVE.:.~ANGES. ETC: For any permit for installing gas stoves, ranges, gas water heater, process gas burners, or other similar gas-burning devices not used in connection with a heating system, the fee charged shall be as follows for each such device included in such permit: INPUT F~~ Not exceeding 99,999 BTU... ............ ............ *$18.00 100,000 BTU but not exceeding 199,999 BTU.......... *$21.00 200,000 BTU but not exceeding 399,999 BTU.. ........ *$35.00 400,000 BTU but not exceeding 599,999 BTU.......... *$50.00 600,000 BTU but not exceeding 999,999 BTU.......... *$70.00 . For inputs exceeding 999,000 BTU, the fee shall be as for gas burners for use in connection with a heating system, which fee shall be in addition to the fee charges as above provided, for the installation of any gas piping for said devices and for any other gas fitting work, if any, included in said permit. INPU~ FEE gAS ~U~,,!ER~~ For any permit for the installation of a gas burner and/or its equipment, for use in connection with a heating system, the fees shall be as follows: . Not exceeding 99,999............................... *$ 18.00 100,000 BTU but not exceeding 199,999 BTU...... .... *$ 21.00 200,000 BTU but not exceeding 399,999 BTU...... .... *$ 35.00 400,000 BTU but not exceeding 599,999 BTU. ......... *$ 50.00 600,000 BTU but not exceeding 999,999 BTU.......... *$ 70.00 1,000,000 BTU but not exceeding 2,499,999 BTU...... *$125.00 2,500,000 BTU but not exceeding 9,999,999 BTU...... *$150.00 10,000,000 BTU but not exceeding 49,999,999 BTU.... *$225.00 50,000,000 BTU but not exceeding 74,999,999 BTU.... *$300.00 75,000,000 BTU and over............................ *$400.00 Where more than one gas burner or multiple gas burner are to be installed in a single boiler, furnace or other device, they shall, for the purpose of establishing permit fees therefore, be considered as a single burner. The above fees shall be addition to the fees charged for the permit for the installation of any gas piping for said burners or equipment. For any permit for alterations or repairs to any existing gas burner or gas burner equipment where the cost of such proposed work does not exceed One hundred dollars ( $100.00), the fee shall be Eighteen dollars ($18.00). Cost shall include labor and all materials used. For each additional One hundred dollars ($100.00) or fraction thereof, in the cost of such proposed work, one dollar and Fifty cents ($1.50) shall be added to the above prescribed fee for such permit. . EXBl13IT E . CITY OF ELK RIVER J>LUM1HNG PERMIT U;ES The Chief Building Inspector, before installation of any plumbing work, require the payment by the applicant the amount herein provided. issuing any permit for the fixture or device, shall for such permit of fees in MINJMVl1 FEE: In no case shall the fee charged for any permit issued by the Chief Building Inspector be less than Eighteen dollars ($18.00). BASIC FEEf?~ (A) . The fees for all plumbing permits shall be computed on the basis of the number of fixture openings, plumbing fixtures or devices provided for in such permits, whether subsequently so installed or not, and the fee for each fixture so provided for shall, except as hereinafter otherwise specifically provided, be Six dollars ($6.00) for each fixture installed or replaced or set only (no waste or vent piping), the fee for each such fixture shall be Six dollars ($6.00). (B) Where any such permit is issued for roughing in plumbing openings only! providing for certain proposed fixtures, which are to be installed or set later, a fee of Six dollars ($6.00) shall be charged for each such opening, which fee shall be in addition to the fee charged for other plumbing work included in the same permit. (C) For the purpose of this article, a plumbing fixtu~e shall be taken to mean and include any sink, laundry tub, bathtub, wash basin, drinking fountain, floor drain or any other plumbing device arranged to be connected with the sewer or plumbing system, either directly or indirectly, and required to be trapped. CITY UTILITY HOOK-UP PERMIT . Building Sewer Plant........ ........ ........ ....... *$18.00 Curb Stop Water Connection Permit.................. *$21.00 Abandoning or Repairing Water Service Permit....... *$21.00 Storm Sewer Connection Permit and Inspection Fee... *$18.00 . ':.~.'.> .. . ALTERATIONS, REPAIRS: For each permit for the alteration or repa1rJ.ng of existing plumbing work not included above, the fee shall be Six dollars and Twenty-five cents ($6.25) for the first Five hundred dollars ($500.00) or fraction thereof in the estimated cost of such proposed work. For each additional Five hundred dollars ($500.00) or fraction thereof in such estimated cost Six dollars and Twenty-five cents ($6.25) shall be added to the above described fee for such permit. . . State Plumbers License: YES NO STREET DISRUPTION OR UTILITY HOOK-UP PERMIT Name of Company or Corporation: Name of individual making application: Company Address: Company Phone: The aforementioned hereby requests permission to disrupt the public right-of-way , and agrees to replace all materials and street surfacing according to the specifications and under the supervision of the Street Superintendent of the City of Elk River. Applicant must also call for appropriate inspections. TYPE OF WORK: Sewer Water Street Disruption Other . INSURANCE Each applicant shall accompany his application with a certificate of insurance. Such certificate shall specifically state that such insurance covers underground operations and shall contain a provision that the coverage afforded under the policies will not be cancelled or materially changed until at least 15 days prior written notice has been given to the City. Insurance Company: Insurance Company Address: Coverage: $250,000 per person $100,000 per occurrence $ 10,000 per property damage $ 2,000 Letter of Credit in Favor of the City of Elk River Date: (,. Signed: 720 Dodge Avenue N.W., Elk River, Minnesota 55330 (612) 441-7420 . . '. NOTE: * NO PERSON SHALL MAKE CONNECTIONS OF ROOF DOWNSPOUTS, EXTERIOR FOUNDATIONS DRAINS, AREA-WAY DRAINS OR OTHER SOURCE OF SURFACE RUNOFF OR GROUNDWATER TO A BUILDING SEWER OR BUILDING DRAIN WHICH IN TURN IS CONNECTED DIRECTLY OR INDIRECTLY TO A PUBLIC SANITARY SEWER. * UNUSED SEPTIC TANKS, CESSPOOLS, LEACHING PITS AND SIMILAR DEVICES AND STRUCTURES SHALL BE BACKFILLED OR MADE SAFE AND UNUSABLE IN A MANNER ACCEPTABLE TO THE CITY. Fee: ($25) Date: Approved by: Lot:al.ioll or Properl.y: Legal DC!lcripti'lIl; liill I.hl~ excllval.ion 01' rill ill:'; be in a: IYal."I'I,,-,ul'!lp._lvf!L1and_lJlilancl_ PUI'plH;e fnl' Lh(, P.'olloseu excavating or ri 11 ing: ,: . CIH OF F.I.I; 1.ln:l. APPf. rCI\TTON FOR KXr.,WATlNG/Frr.l.rNG rmmT . Pel'HI i L No. Oal.l'_/_/_ Phoneli ApI'] iean t ,\tld n'ss; PI'opel'l.y Owner; Address; COIII.I'a(;l.ur: ,\chll'ess: Consultant Engineer/Survp.yol' ,\dd rl'ss; Phone# Phone# Phone# ".. I. i mal.ml s tal'\. dat.e; Cl.Impl.,l.ion dat,,: Whnl. is LIllI I.ype of mal.et'inl 1.0 he 1"lmOV,!d 0" d,'p,'sil...d: ':~ . lu whal. manlier will. the mal,!rial be I'emov,ld alld/o.' deposit.ed? .. WhaL hi~hwny, sLreet, or nUll'" puhlil: I;I\~' "i.ll matt'rial fOl' removal 01' der/osi tatioli be h:wled 01' cardell':' !ihaL, if any, street, aVP.lllle, lau., alley, highway, right of way, thoroughfarc 01' vublic grounu wi I I hE' ohsl.t'ucl.ed':' IT SHM.L BE THE RES PONS TIn L IT'" ;\ND TilE BURDEN OF THE APPLI CANT TO DEMONSTRIITF. TO THE SATTSFM:TION OF TIIF. r.JTY mlTT.DING &. 7.ONING ADMINISTRATOR FOR THE CITY OF F.LI\ "HER TIL\T TIlE PROPOSED EXCAVATION MiD/OR FIr.LING COMPLIES IvITII TilE l\prr.ICAnLF. CITY ORDrN,\NCES OF ELK RIVER. SAID RIIRDF.N SHALL INCLUDF. TIlE FllRNISHIi';r. OF ,\ RF.PORT lHTH SUPPORTING CAI.CULATIONS OF A REGISTERED PROFESSIONAl. F.NI-;TNF:ER, IF RF.QUIRF.D. SlJRmSSION REQUIRF.MKNTS; I.i me 0 f apld i CIl Li on a I. ,\dmj n i stn1tor' , TIll" t.he fllllo\4illg it.f!nl!,; !lhall hI" submitt.eu al. t.he di!';c:!'et.ion of I.ht! Building and Zoning . , . (,\) ClIOIpl,'(yd al'l'l icaLioll fo/'m (n) (;onl\oI"t.e" l"gal description (r.) Map 01" I'lal. of I.he PI'ol,,',sed fi lJing or excavating !lhowing locat.ion and amoullt of mal.l!,'jal p,'oposlld 1.0 be I"cmllved 01" delmslt.ed, wi th a description of l.he a/'N1 (0) Tlte depth or heighl.s t.o which SIICIt reOloval or deposi t.ion is I""opo!l<'ld I.h/'ougll the area and t.he proposed 11IIS 1 e nf all slopes to be shown 011 a 2' COli Lou I' map at a scale of I" = ;'0' 0" ];lI"gel': The proposed and Ilf'igill:il <:nIlI.OIlI'S shall he 5ltO"" inclllding al 1 IH"OI"'I't.~, withill 1;'0' of 11I'ol'us..d pxcavaLion 01' deposition an" slmll I,," siglled hy an engi/H~p.r 0/" SIII'VCY,'!' I'egisl..:.";.:tl in U,e Sl.al.e of ~Iinne!lnl.a (E) F.1'I)sion control plan (F) Afr,",1. Oil .,xi5I.ing utili!.i!'s (G) Prol.t'C"Liun of site hy erection of !ll/it.ahle f.~nce, guarcl 01' harl'icnde (H) AppTical.inll fIle (I) Bond, l,~tl.el" of C1'l'dit, 'iI" d'~i'osit of moni,'!; in a 5um suffici'~1I1. 1.0 pay t1lf! CO!lI. of l'esL(trin~ a si.l.e. The ,',;d.I'a o!'dinary cnsl.s of ,'epairing, highway!';, l'1.1'''l'I.l' or' oU",r" pl/bl ic l>ays ah,jlg d,'sigllat..t1 ['ol/t.es of travel Ilnd 1.0 pay SIlCIt ex 1l'-llsr,s lI!. the C i l.y lIIay i IICll r' by J'eal>O" II f do i rog any Lit j ng rp.'l" i I'cd tu I.., donp. (,T) Public liaiJilil.~' inslll':lIlCO.'. . ',', ,\mOlln L (I r bond Lel.l.el' of en~di I., Ii aL i Ii t~. i lI!;ur'ance prov i ..ed Siglrlll.lIl'e (If apr,] ican!. P",'mi I. dl'(lIll'i I. Hili hlil'S &. loning Arlministr'lltol' or deposit. uf money Pe,'m it fee DaLe ',' ,~. . .,'1:,,' . ,'" 0.. '::'{:;.' Dat.e .,.. " . . .... . .\.... .' ~ .. ,. ......,'.: