HomeMy WebLinkAboutPR 2.3.13; PROPERTY ELLSWORTH; Engineering Application,l 1
App I i cat i dn f9r Grading Perr.
PERMIT No.Pr.tt,U
(letter code+ number)
0-1 TY OF CARLSBAD ' L=lot
PUBLIC WORKS\& ~UILDING DEPARTMENT S=subdivision
1200 Elm Avenue
729-1181
C=City contract
FOR APPLICANT TO FILL IN
Site Address
Elm Avenue
Legal Description Map No.
Por. Tract 119 Carlsbad Lands 1661
Subdivision Name
Phone
San Phone
Street o i e o 225-9337
oi I Engineer R.C.E. 14129 Phone
Woodward-Gizienski & Assoc. 224-2911
rading Contractor Phone
Check if supervised
arty responsible for overal I supervision
grade site
of cubic yards
Fi 11 Im ort
1441
ompacted fi I Is (yes or no)
Yes
Proposed Schedule of
0 erations (dates)
Waste
3350
Finish
I hereby acknowledge that I have read the appl ica-
Surety Bond
Surety Company
Surety Address
Date Fi led Rec'd by
Cash deposit Rec'd by Date filed
$
The fol lowing documents are required and shal I
become a part of the grading permit when they
are approved.
~rading plans
_;xso i I report
~Drainage structures
~Compaction report
X:Specifications
kVicinity map
_Retaining wal Is
Other
SPECIAL CONDITIONS WHICH ARE MADE
A PART OF THIS PERMIT
I. Authorized hours of o eration: 7:00 AM to
5:00 PM, Monday-Friday.
2. Haul routes are to be a
Engineer.
3. Ade uate rovisions shal I be made for
erosion and siltation control.
4. Al I sloes shal I be I anted er direction
of Parks & Recreation Director.
----------------------c--t ion and state that the infor I have provide INSPECTION DATE INSPECTOR'S
is correct and agree to comp I I I City SIGNATURE
ordinances and State laws e vating an Ground preparation
grading, and the provisio I ns of any
permit issued pursuant t Rough grading
Compaction report rec'd.
Signature of Permittee -79""---~-,,i<-J=--""---"-....;_---Planting & drainage
O w n er or authorized a Final certification rec'd.
Grading permit fee $ 102. 00 Work completed
Surety bond released
Permi! VaJ,i,i1,,adja7t_;8in n,,.,,. ,AJ/} /)
by /t/"/~ ~Date t}er, -=-=-£.1.'.=.J.~:..,l
Permit Expiration Date /2j:p~ /9 ?~D
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