HomeMy WebLinkAboutPE 2.8.22; LA COSTA SOUTH UNIT 1 LOT 73; Engineering ApplicationApplication for Grading Permit
PERMIT NO.%
(letter code + number)
CITY OF CARLSBAD L=lot
PUBLIC WORKS & BUILDING DEPARTMENT Ssubdivision
1200 Elm Avenue C=City contract
729-1181
Site Addr ss
FOR _APPLICANT _TO_ FILL _IN
04_
Surety Bond Bond No.
Legal Description Map No. Surety Company
L—O-T r7 4 LcCT
Subdivision Name
A-_C
-e-.11t Surety Address
Owner Phone Date Filed Rec'd by
-' -<LZ 4
Owner's Address zzco . c Cash deposit Rec'd by Date filed
$
P lans by Civil Engineer R.C.E. The following documents are required and shall
t)iii Dici/t. -Psoc_. tlr-I- become a part of the grading
are approved.
permit when they
¼d dress Phone
_Grading plans
Soil report
_Specifications
Vicinity map Soil Engineer R.C.E. Phone
Drainage structures
_Compaction report
_Retaining walls
Other Grading Contractor Phone
ddress Check if supervised
grading
arty responsible for overall supervision
'i tL4_j
roposed use of grade site
S
umber of of cu Vic yards
Cut Ra 'Fill Import Waste
oI I 1 9co
Dtal
pacted fills (yes or no)
SPECIAL CONDITIONS WHICH ARE MADE
A PART OF THIS PERMIT
Authorized hours of oDeration: 7:00 AM t
5:00 PM, Monday-Friday.
Haul routes are to be approved by City
Engineer.
Adequate provisions shall be made for
erosion and siltation control.
All sloDes shall be Dlanted Der direction
of Parks & Recreation Director.
- INSPECTION DATE INSPECTORS
SIGNATURE
Ground preparation
Rough grading
Compaction report rec'd.
Planting & drainage
Final certification rec'd.
Work completed
Surety bond released
Permit Validation
Permit Expiration Date May 19, 197
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
Proposed Schedule of Start Finish
Operations (dates)
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 an c
grading, and the provisions and conditions of any
permit issued pursuant to this application.
ignature of Permit-t-ee_____________________
wner or authorized agen
Grading permit fee $78.00. (Paid)