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Building Permit Plan Check No.
Application for Grading Permit
CITY OF CARLSBAD
ENGINEERING DEPARTMENT
1200 Elm Avenue
438.5541
PE NO. _____
Validation by Finance
Department
8/0' q63956 11i9SO0 MO
FOR APPLICANT TO FILL IN
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Surety Company Bond No.
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Surety Address
Subdivision Name
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Date Filed Rec'd by
Owner Phone Cash deposit Rec'd by Date filed
Owner's Address5'SZO fli*4aSfa4t A44W5 —2710 Z",
_S44'M qz'?./ The following documents are required and shall become a part
of the$,rading permit when they are approved.
1.' Grading plans ' Specifications
" Soil report Geologic Report
Drainage structures _____ Other
Compaction report
Plans by Civil Enaineer R.C.E.
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Soil Engineer R.C.E. Phone
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Grading Contractor Phone
M4tx A'lejI'Ii1ELL. Co 7,'YZ-4z7O SPECIAL CONDITIONS WHICH ARE MADE
A PART OF THIS PERMIT
Address ~4A
T' ?9 7iEsiE?4 4AA 442 iI2PL Authorized hours of operation:
7:00 AM to Sunset, Monday - Friday.
- Party responsible for overall supervision
Haul routes are to be approved by City Engineer.
Proposed use of grade site
ii4b1 ',t'i2 Adequate provisions shall be made for erosion and siltation
control. Number of cubic yards ff, AIR'JV 'IT'E
Cu Fill Import Waste All slopes shall be planted per City Code.
All fills to be compacted to at least 90% of optimum
density unless noted otherwise.
Prosed Schedue of Start Finish
Operations (dates)
I hereby acknowledge that I have read the application and state that
the information I have provided is correct and agree to comply with
all City ordinances and State laws regulating excavating and grading,
and the provisions and conditions of any permit issued pursuant to
this application.
Signature of Permittee
Owner or authorized agen %
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Under City Code Sec. 11.06 170 this grading is:
D REGULAR GRADING - City inspector will make inspections
listed below. o CONTROLLED GRADING - Private grading engineer shall
observe work, coordinate tests, make reports.
INSPECTION DATE INSP. SIGNATURE
Initial - site prep. /
ENVIRONMENTAL CLEAVANjE -
Vate 1%N I I 1~~OvZgel
EIA Log No.
- By
Rough - prior to drains
Final - slopes planted
Compaction reports rec'd. Grading permit fee $ 34? Plan check fee $
Private engr. cert. rec'd. Permit Issued - -
Date 7 (' - Copies: White-Office; Green-Building; by
IV Yellow-Inspector; Pink-Permittee; Goldenrod-FinancO Permit Expiration Date
THIS FORM WHEN PROPERLY VALIDATED IS A PERMIT TO DO THE WORK DESCRIBED
THIS PERMIT IS VALID FOR A SIX (6) MONTH PERIOD