HomeMy WebLinkAboutCT 85-09; VISTA SANTA FE AREA B; Engineering ApplicationCITY OF RRLSBAD - ENGINEERING D•ARTMENT
APPLICATION
GRADING PERMIT
PROJECT NAME: ,e'&c/, C7 PERMIT NUMBER:______________
PROJECT LOCATION: Ca//e 3:7,-Ca// Acc,va
ASSESSOR PARCEL NUMBER(S):
PROJECT DESCRIPTION: /'2 '/e
OWNER:
ADDRESS: 9'/9/ 7'iie Ccn7-e Zyive , '// 4 -/0/, S, Z2ie5 ô . Cap.
PHONE NUMBER: (/'f) 'r? -7/W
.1 CERTIFY THAT I AM THE LEGAL OWNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT.
OWNER SIGNATURE /tZ c.L2 As.s7z sec. DATE: 2-F /1'i5r3
CIVIL ENGINEER: 2'A C.
ADDRESS: ° Za/, Sw Z'ieç , Ca. -
PHONE NUMBER: ('/) 2I/-07 07
SOILS ENGINEER: Zc.
ADDRESS: 3'qç/ L'm, Pô41 &;fe 9205. 5'a Die O! Ca. qvzj
PHONE NUMBER: (/T) 2Z- 'o3c
GRADING CONTRACTOR: e ce/ec/ed STATE LICENSE NO.:__________
ADDRESS: CITY BUSINESS LICENSE NO:______________
PHONE NUMBER:
BASIS OF PERMIT FEES: cy.
GRADING QUANTITIES: 53occ cy cut 4Zz , cy fill
cy remedial /15 4 ICO cy export/Import
VERIFIED
TOTAL PERMIT FEES: BALANCE DUE: BY:
I hereby acknowledge that I have read the application and information provided is correct. I agree to
comply with all City ordinances and state laws relating to excavating and grading, including OSHA permit
requirements for trenches over five (5) feet, and the provisions and conditions of any permit issued
pursuant to this application.
APPLICANT NAME f- Vale 47cc ci PHONE NO.('/2) '/SJ..7//
ADDRESS: 9'J'I/ 'n.' ce4y4e 2j-,ve. S b,ea Ca '5Z/Z7
APPLICANT'SSIGNATURE:2~z 4ss,.r/ sec. DATE: 2',/53
0
P:\D0CS\MISF0RMS\FRM00065 • • REV. 03/08/93