HomeMy WebLinkAboutPD 2019-0006; ABEDI MOGHADDAM FAMILY RESIDENCE; Engineering ApplicationAPPLICATION
GRADING PERMIT
E-24
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
Project Name: --l..l...µ.~~t;;.._-,.....i.::J..,L...i.:;..i...i...:..:.J:a::;.J..!..JI...I..___JL...LL.l-.1-1,...:'=./.-.L.:;..:::
Project Location:
Assessor Parcel Number(s):
Owner: G c,.,..
Address: / ftU ~ &~ t\J (9 { R--,
City: L-c:;, f (). '{) 1==-C::.-A-7.<f't-State: t_ /+--
Phone Number: q tJ: 6( -8~7 -Z3 k:,Z-· Fax Number:
I certify that I am the legal owner of thffi~operty and I authorize the grading associated with this permit.
OWNER SIGNATURE: .RJ ?-W , ,I;" ,,,.-· DATE: .
Civil Engineer: it!--• ~ 0,. c,, S I
Address: t c;4s; Mt ()(?-R--:{) U&--o gD ,
City: C.-l..EN o fr< G'" State: CA
Phone Number: ·8 Fax Number:
Soils Engineer: --'-'--=...o..;....;;...--,.~"'""'-...__ __________________________ _.
Address: <2-I .z_ I M Q N ·ctt:Z.✓
City: "2 /t-
Phone Number:
R-a tt-C), 7
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Qualified contact person trained in NPDES requirements:
Phone Number: ,,8, ti A ~
cf &t--1: l>4 19:{?.., c_() c;
State: ? It
Fax Number:
State: rC,./f--
fill / lf'"l &? V
Basis of Permit Fees: cy Total Permit Fees: $ ------------------------1 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:
City:
Phone Number:
--1~.:..;..::::;,...i..:...::~"'----!,--=.;.=;...:::;.....:::::;...:a.L..!..,L;:i;._ __________________ _....
State: _ _..e.,::;;...i,&:'--"· ___ _
APPLICANT'S SIGNATURE:
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