HomeMy WebLinkAboutPE 2.7.4; AVENIDA ENCINAS BURROUGHS CORP.; Engineering ApplicationSuPPORTING
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Application for Grading Pert
CITY OF CARLSBAD
PUBLIC WORKS & BUILDING DEPARTMENT
1200 Elm Avenue
729-1181
PERMIT NO._________
(letter code + number)
LIot
S=subd ivis ion
C=City contract
FOR APPLICANT TO FILL IN
Site Address Surety Bond Bond No.
5100 AVEWibT\ E1NCIA/fS 1 c,cRLS,jr
Legal Description Map No. I Surety Company
ubdivision Name Surety Address
r
wner Phone Date Filed Rec'd by
3uRRouGM..S CORP,
ner's Address
pe' A V —Af/iDf'E N CiN/?3,C,<
lans by Civil Engineer R.C.E.
ddress Phone
c74L544'e,v/1i EIVL,iyi
oil Engineer R.C.E. Phone
!1LPI-/?1 I_A0J?RATpRj&S 0"o
rading Contractor Phone
rt i/f?ACbN57 Co, 7Is4Ic
ddress Check if supervised
B grading
arty responsible for overall supervision
Cash deposit Rec'd by Date filed
The following documents are required and shall
become a part of the grading permit when they
areyapproved.
9rading plans jpecifications
VSoil report VVicinity map
Pcompaction
rainage structures Retaining walIs
report Other
SPECIAL CONDITIONS WHICH ARE MADE
A PART OF THIS PERMIT
Authorized hours of oDeration: 7:00 AM to
roposed use of grade site
umber of cubic yards
Cut Fill ImDort Wa
00 I I'iOl.IE I
[ota I
Sc7c
Compacted fills (yes or no)
Proposed Schedule of Start Finish
Operations (dates) AT /7t OF PEf,1i17
I hereby acknowledge that I have read the applica-
tion and state that the information I have provide
is correct and agree to comply with all City
ordinances and State laws regulating excavating an
grading, and the provisions and conditions of any
permit issued pursuant to, this aj,Jon.
Signature of Perm i ttee C2141
Owner or authorized age
5:00 PM, Monday-Friday.
Haul routes are to be approved by City
Engineer.
Adequate provisions shall be made for
erosion and siltation control.
Al! sloDes shall be Dlanted oer direction
of Parks & Recreation Director.
INSPECTION DATE
Ground preparation
Rough grading
Compaction report rec'd.
lanting & drainage
Final certificationrec'd.
INSPECTOR'S
SIGNATURE
Work completed Grading permit fee L3 Air. Surety bond released
Permit Va I on
by Date 0 "75" /
Permit Expiration Date Oc>°P15
THIS FORM WHEN PROPERLY VALIDATED BY SIGNATURE IS A PERMIT TO DO THE WORK DESCRIBED
THIS PERMIT IS VALID FOR A SIX (6) MONTH PERIOD