HomeMy WebLinkAboutCT 2017-0003; LA COSTA TOWN SQUARE PARCEL 3; Engineering Application
E-24 Page 1 of 1 REV 07/14
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
APPLICATION
GRADING PERMIT
E-24
PERMIT NUMBER:
_______________________________ Project Name:
___________
___________
___________
___________
_______
Project Number:
Project Location: Drawing Number:
Assessor Parcel Number(s):
Project Description:
Owner:
Address: Suite:
City: State: Zip:
Phone Number: Fax Number:
I certify that I am the legal owner of this property and I authorize the grading associated with this permit.
OWNER SIGNATURE: DATE:
Civil Engineer:
Address: Suite:
City: State: Zip:
Phone Number: Fax Number:
Soils Engineer:
Address: Suite:
City: State: Zip:
Phone Number: Fax Number:
Grading Contractor: State License No.:
City Business License No.:
Address: Suite:
City: State: Zip:
Grading Quantities: cut cy fill cy import cy
remedial cy export cy
Qualified contact person trained in NPDES requirements:
Phone Number:
Basis of Permit Fees: cy Total Permit Fees: $
Verified By: Balance Due: $
I hereby acknowledge that I have read the application and information provided is correct. I agree to comply with all
federal, state, and city laws, ordinances, regulations and policies relating to excavation and grading including, but not
limited to, the Federal Endangered Species Act of 1973 and any amendments thereto. I will also comply with OSHA
Permit requirements for trenches over five feet deep and the provisions and conditions of any permit issued pursuant to
this application.
Applicant Name:
Address: Suite:
City: State: Zip:
Phone Number: Fax Number:
APPLICANT’S SIGNATURE: DATE:
II
~
r_N--"\