HomeMy WebLinkAboutPE 2.11.04; HILL|ADAMS STREET; Engineering ApplicationIWIpplication for Grading Permit 441
CITY OF CARLSBAD
PUBLIC WORKS & BUILDING DEPARTMENT
1200 Elm Avenue
729-1181
PERMIT NO.jQj[
(letter code + number)
L=lot
_2/06/ES%division 57;oo ,ic
C=City contract
FOR _APPLICANT _TO_ FILL _IN
Site Address
34 74 ADA "S Surety Bond Bond No.
Legal Description Ma Surety Company
Subdivision Name Surety Addre
,
y'
Owner Vt! Ji 7zq- 83o Phone (w) 43B/,q, Date Fi Rec d by
Own is Addrqqs
3255' E,41,D1V1-4-f?-4( LA), c49S17*0
Cash deposit Rec'd
$
by Date filed
Ians by Civil Engineer R.C.E. The following documents are required and shall
become a part of the grading permit when they
Address Phone are approved.
t.-'rading plans Specifications
Soil Engineer R.C.E. Phone 1—Soil report Vicinity map
ainage structures Retaining walIs
rading Contractor Phone Zcuompaction report Other
ddress Check if supervised SPECIAL CONDITIONS WHICH ARE MADE
I grading A PART OF THIS PERMIT
party responsible for overall supervision
I. Authorized hours of operation: 7:00AMto
roposed use of arade site 5:00 PM, Monday-Friday. __IWaC,,iJb '#fói Fv/I. p 2.HaulroutesaretobeapprovedbyCity
Jumber of cubic yards Engineer.
Cut Fill Import Waste Adequate provisions shall be made for
erosion and siltation control. 7tJ _-Z 8 I_
All slopes shall be planted per direction
of Parks & Recreation Director. Total
r
ompacted fills (yes or no)
Proposed Schedule of tar)- Finish
Operations (dates) I//O/cS
I hereby acknowledge that I have read the applica-
tion and state that the information I have provided
is correct and agree to comply with all City
ordinances and State laws regulating excavating and
grading, and the provisions and conditions of any
permit issued pursuant to this application.
ignature of Permittee______________________
iner or authorized
INSPECTION DATE INSPECTOR'S SIGNATURE
Ground preparation
Rough grading
Compaction report rec'd.
Planting & drainage
Final certification rec'd.
Grading permit fee $ Work completed
Surety bond released
Permit V Vda ]t i 2n
by _Date____
Permit Expiration Date___________________________
THIS FORM WHEN PROPERLY VALIDATED BY SIGNATURE IS A PERMIT TO DO THE WORK DESCRIBED
THISPERMITISVALIDFORASIX(6)MONTHPERIOD