HomeMy WebLinkAboutPE 2.9.36; LA COSTA FIELD OFFICE; Engineering ApplicationPERMIT
(letter code + number)
Llot
S=subd iv is ion
C=City contract
plication for Grading Permit
CITY OF CARLSBAD
PUBLIC WORKS & BUILDING DEPARTMENT
1200 Elm Avenue
729-1181
FOR APPLICANT TO Fill IN
Site Address 1-4 cew Ate Surety Bond Bond No.
Le, Description Map No. Surety Company
Subdivision Name
Afr ,'V141#2F
Surety Address
Owner Phone
Z9 6SA-4
Date Filed Rec'd by
Owner's Address Cash deposit Rec'd by Date filed
$ P lans by Civil En
J
neer R.C.E.The
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following documents are required and shal
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 -
Address Phone
'A416 zd/& 79-19ö7
Soi_L Engineer R.C.E. Phone
/g/p.?
ra ng QDntractor Phone
Address Check if supervised
grading
SPECIAL CONDITIONS WHICH ARE MADE
A PART OF THIS PERMIT :Iar.tv, re onsible for overall supervision
jrA I. Authorized hours of operation: 7:00 AM to
roposed use of grade site
,'a/i ,y
5:00 PM, Monday-Friday.
Haul routes are to be approved by City
Number of cubic yards
Cut Fill Import Waste
Engineer.
Adequate provisions shall be made for
erosion and siltation control.
All slopes shall be planted per direction I f17' I S90 f of Parks & Recreation Director. Total 1f7&t
Compacted fills (yes or no) co-s
Proposed Schedule of Start Finish
Operations (dates) 1'O 97 /1 e€?7
I 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 and
grading, and the provisions and conditions of any.
permit issued pursuant to this application.
Signature of Permittee
Owner or
INSPECTION DATE INSPECTOR'S
SIGNATURE
Ground preparation
Rough grading
Compaction report rec'd.
Planting & drainage
Final certification rec'd.
Grading permit fee $ Work completed
4 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