HomeMy WebLinkAboutCT 72-24; SPANISH VILLAGE; Engineering ApplicationQ
I. PRESENT ZONE TYPE
FOR APPLICANT TO FELL IN ). /
SITE ADDRESS . .. . . .- . . . . REMARKS (IDENTIFY SPECIAL USE PERMIT OR OTHER SPECIAL SPrQftifii ViL_rQE . .. . . . ZON(N REQUIREMENTS'AFFECTII4G THIS WORK.)
LEGAL DESCRIPTION MAP NO. '.
SUBDIVISION NAME
OWNER: . . . PHONE SURETY BOND . BOND NO.
OWNER'S ADDRESS .. . . S SURETY COMPANY
30 J S' S7q7E S/-
PLANS BY CIVIL ENGINEER .. . . R.C.E. . . SURETY ADDRESS . . .
ADDRESS . .. . -• PHONE .. DATE FILED . RECD BY .
-. S.. 7 2 £qt/u //o'7 . A' ..- .- .J'T1f 76 . .. . .
SOIL.ENGINEER R.C.E. . . PHONE:. CASH DEPOSIT REC'O BY DATE FILED .
. S.. . $ .. .. .5 .
GRADING CONTRACTOR STATE LICENSE PHONE 9 THE FOLLOWINGDOCIJMENTS ARE REQUIRED AND SHALL BECOME A
S .
. PART OF THE GRADING PERMIT WHEN THEY ARE APPROVED. THEIR
SUBMISSION IS WAIVED IF THE ITEM IS CHECKED.
ADDRESS CHECK IF . . . .
SUPERVISED I GRADING
. j LV . _.GRADING PLANS _. VICINITY MAP
ENGINEER RESPONSIBLE FOR OVERALL SUPERVISION P.C.!. _SOIL REPORT RETAINING WALLS
. . . .
DRAINAGE STRUCTUES, ECT.
PROPOSED USE OF GRADED SITE . . . .COMPACTION REPORT
.R/p,'(L Z-.' • . .
.5 -. SPECIFICATIONS OTHER - ..
NUMBER OF CUBIC YARDS
ON IMPORTED TOTAL SPECIAL CONDITIONS WHICH ARE MADE A PART OF THIS PERMIT
. CUT SITE FILL FILL WASTE CUT & FILL .
57 75 0
COMPACTED FILLS Ld 41 YES NO J
PROPOSED SCHEDULE OF START FINISH
=- iJS2 #1
I HEREBY ACKND,,'LEOGE THAT I HAVE READ THE APPLICATION
AND SAE AEI OR IAOAVEPPOVIEO IS CO. REC
"/ •/)
LAWS REOULATINO EXCAVAT!NG AND GADINO. AND THE PROVISON AND CONDITIONS OF ANY PERMIT IS-L'_= PURSUANT TO THIS APPLI- CATION. .
- INSPECTION OAT! INSPECTOR'S SIGNATURE
X~Z /w, ,_:z -SIGNATURE OF PERMITTEE 5- f
OWNER OR AUTHQRIZEC AGENT Com:i rerrr:'d.
DEPOSIT FOR STJ.TURE INEP. Esr:MATZD .137 - :.3K
Fir,:I ccanc'd.
PLAN CHECK FEE . I0R_OI P!R-iIT FE . . - WA c crp'-r1
PLAN CHECK~,
Approved b D 3/jq/2
PERUT . . S .CK
By Datc- LJCA 3N
THIS FORM wH:-: OPELY VL!DATEO ' SG\TU,RE
IS A-P;T Ta DO THE WOR- DESCR-SED.
-