HomeMy WebLinkAboutPE 2.11.22; OAK INDUSTRIES PARKING LOT 15; Engineering ApplicationPERMIT NO.Z112.2_
(p cation for Grading Permit • • (letter code + number)
CITY OF CARLSBAD Llot
PUBLIC WORKS & BUILDING DEPARTMENT 7/29/BES7iJbdivigjonJ000 BP
1200 Elm Avenue TL 729-1181
FOR APPLICANT TO FILL IN
Site Address 1 Surety Bond Bond No.
Legal Description Map No. Surety Company
Pøitmj Lor IS Ptu3.P. Urr 41 2os4.
ubdivision Name
iner U7E'tl.) Phone 432 -IZJ
Fl C 7t-pM a (f0 (OWu)
anerls Address
lans by Civil Engineer R.C.E.
iciy Woy / 8 &IZ3
idress - - Phone
,) '.-JjI., VT./ I • •-*J y p j I -•I1
ii Engineer R.C.E. Phone
rading Contractor Phone
Surety Address
Date Filed Rec'd by
Cash deposit Rec'd by Date filed
The following documents are required and shall
become a part of the grading permit when they
are approved.
_Grading plans Specifications
_Soil report _Vicinity map
_Drainage structures Retaining walls
_Compaction report _Other
ddress Check if supervised SPECIAL CONDITIONS WHICH ARE MADE
I grading a- A PART OF THIS PERMIT
party responsible for overall supervision
Authorized hours of oDeration: 7:00 AM to
osed use of cirade site
umber of cubic yards
Cut Fill Import Waste
I I -
otal
acted fills (yes or no)
Proposed Schedule of Start Finish
Operations (dates)
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 thi application.
Signature of Permittee_________________________
Owner or authorized agent cyLhK.a.
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 sIoes shall be Dlanted Der direction
of Parks & Recreation Director.
INSPECTION DATE INSPECTOR'S
SIGNATURE
Ground preparation
1WJUJII :JIOUIIIY
Compaction report rec'd.
Planting & drainage
Final certification rec'd.
Grading permit fee $ Work completed
Surety bond released
Permit Validation
by Date
Permit Expiration Date___________________________
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