HomeMy WebLinkAboutCT 73-50; JEFFERSON STREET; Engineering ApplicationFOR APPLI CANT TO FILL IN
Site Address ~S$S ::J1t:1"~crr$DI'2 .s~I"'tf(/,', Ctt:lrbbt:Pd
Lega'i Oescri ptionp~r'll(jJrl t:;r Ma~. sac. I r. It? S /,]', --6t..J • .9./iJ. S.I! /"z ;::;,.,./.Jh4
bwner
. :;ifPlu? /'4 tt: /,:"'ee n 4. .
Owner's Address
2525 ;1eA'lr $r?j2 5'1.
PI~ns by Crvil EngFneer 6lr,.::?.q .s;."",;.0 CI?,9/Q£t?1'r Jb~. R.C.E: I!J 8/7
::,oi I Engi neer R.C.E. Phone
" Grading Contractor
~ddress
PhonE?
Check if supervised
gradi'ng. v/
Party responsibl-e for overql,1 supervision ~
Proposed use of grade site A?eJ,~e~~~"
COl?dom/q, r,.;1'I?
Number of cubic yards
Cut Fil,. Import Waste
Compacted fi I I s (yes '0'~e~
Proposed Sched~le 6f Start
Operations (dates) JUL-Y a Fi ni sh A,t-ttG Z.
. Commission before :g!ling. fillward witb your project.
.118dcp~I1!l,r:~~v~q:r'l'(ed<..:re and acknowlC{\ge~,IJXN~
of. {l)m:'liailc~ \'J:t~ tl;:; r~'C;uir,;<11rn~$ of r:~;')$:(O(!::'J (Div, 18,
(~~~f.~', (G~~at:lo/:;c(}, 'Publ:c. Q::~!lllfC:!l$ Ct.":), ik..tor~ . / .. _--__ . IPf\)~eedm9 with this prJ,ed,1 /' .~,.,." .. I ,""/.L( "
Cashdepos i't
_$
The f'o II owi ng documents are requ i red and shal I
become a part of the grading permit when they
are approved.
_ .. _Grad i ng plans
_. Soil report
_Orai.nage struc;:tures
_. Compact'i on report.
___ Specifications
_Vicinity map
_,'_Reta i n i ng walls
_Other
SPECIAL CONDITIONS WHICH ARE MADE
A PART OF'THIS PERMIT .
I. Author-ized hours of operation: 7:00 AM to
5:00 PM, Monday-Friday.
2. Haul routes are to be approved by City
Engineer.
3 .. AdeqUate prov i s ions sha II be made for
eros i on and s j I tat i on contro·l.
4.,A.l1 slo.pes. shall be planted per direction
of Parks & Recreati·on Oi rector.
thereby acknowledge that I have read the applicap
tion and state that the in format i on I have p rov i dedJ--~, ..... 1 N-S-P-E-CT;--I Q'-.N---------D-A-T-E-"'"':I:-':"N:"::S'=P=EC::':T='=07.:R:-:'-:::-S
is correct and agree to comp Iy with a I J City SIGNATURE
ordinances and State I,aws regulati'ng excavating and 'Ground preparqtion
grad~ng~ a.nd the provisions ~nd CO~?i~ti'?ns 0. ,kan:y/l--i-RO-U ..... 9...,.h-g-ra-d...,.i:-n-g----------~-----
permit Issued pursuant :;zto this application. I
/' 'Jd> . / Compaction repo'rtrec'd.
Signature of Permitt~,e,L: t1L _ ./k) ( -~./Ut'j , I--:o:-.-~~~----,.........-.:----------------------
Owner or author i ztcr"4e~t • p-r r .... -. : P I ant i og& drainage
HF,i'na I cert i f. i cat i on rec' d •
. I,
Grading permit fee $ C)'I) ..t;jt •. ' ~~~ 1I3f/74 . Work comp I eted
S'urety bond te I eased
Permit Expiration Date /Iz /7J-
~ " ' .
THIS FORM WHEN PROPERLY VALIDATEP BY SIGNATURE IS A PERMIT TO DO THE WORK DESCRIBED
TH,/.S .PERMIT IS VALID FOR A SIX (6) MONTH PERI'OD