HomeMy WebLinkAboutPD 15-13; GIBRALTAR VIEWS; Engineering ApplicationC
( City of
Carlsbad
APPLICATION
GRADING PERMIT
E-24
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
I PERMIT NUMBER:
Owner: -6 c..' &
Address: 7~91 &1iR,;J. t.. T Ad. S1'
City: CA 12..L,.( €.Ab State: ~cA~---
Phone Number: fj(i S: , z._. '1 g . 3 8.S-i, Fax Number:
I certify that I am the legal owner of this prope'»' and I authorize the grading associated with this permit.
OWNERSIGNATURE: ') '.,..._,,{ j{_ DATE:
1 Civil Engineer:
Address:
City: '?~.r..
Phone Number:
\),q_~O State: _Gfl"~.__ ___ _
"J <"6S SJ ~ \.\_ '1 4 -a-7 ~ ~ Fax Number:
Soils Engineer: _ __......,..___.__,,..._....._........,.-'---+---+-----,...----------------------1
Address: Suite: ---'--=--'------t
City: ':::,:::..." \t.Jb
Phone Number: Fax Number:
State: Zip: --------
'-.t Grading Contractor: v...'<'-, \ State License No.:
~ r \ I) City Business License No.: ~ Address: q S-fa { ~ ~-e,10-\ t, ~ "-o~~ -S-ui-te-: ------
Q: City: Sc,..""' \-t.L State: _'=1>i......,______ Zip: -->-a-"'---'----
\
Grading Quantities: cut _____ cy fill ______ cy import ______ cy
remedial cy export cy 1-----~~------1
Qualified contact person trained in NPDES requirements:
Phone Number:
Basis of PermH Fees: cy Total PermH Fees: $
----------------------1 Verified By: Balance Due: $
I hereby acknowledge that I have read the application and information provided is correct. I agree to comply with all
federal, state, and city laws, ordinances, regulations and policies relating to excavation and grading including, but not
limited to, the Federal Endangered Species Act of 1973 and any amendments thereto. I will also comply with OSHA
Permit requirements for trenches over five feet deep and the provisions and conditions of any permit issued pursuant to
this application.
Applicant Name:
Address: I/po A/ (,P; ;µ'T~Y Cl k'' d Ptl
City: S: ,rr, , ' • • State:
Phone Number:
APPLICANT'S SIGN
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