HomeMy Public PortalAbout4833, 4825 AGNES AVE_Grading_6/6/1979_ -� �• APPLICATION FOR GRADING PERMIT
76A641 V-CE607B 12-75
BUILDING AND SAFETY DIVISIONke
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FOR APPLICANiT TO FILL IN AIDDRESS &
ADDRESSGG/TJ t LOCALITY ��, ��• `� C/� y
NUMBERS •� / BLOCK NEAREST
CROSS ST
TRACT 7 7 • _ y, _ _ DISTRICT N MAP NO STATE HWY P ES D BY
NUMBER -3 •_.7 .2 Q/�s YES [3 NO
�OWNERr / /Y- t/ Gc•F. r + U E SPECIAL
MAIL COCypITIONS '
ADDRESS �jl� / % �J OZl
CITY �J- �y/�� NOL. Z i
G�,pC�/ ,REGI NO 7V _ .. .
ENGINEER
MAIL' ^' • `/ '4 BOND ��+ NOND - Va •I
ADDRESS p!L o C
___ / L SURETY
CITY NOy,$� COMPANY
GRADING TEL DATE RECD
CONTRACTOR - - NO FILED�� leg BY
ADDRESS r CASH RECD DATE a
DEPOSIT ; BY FILED O
PROPOSED USE 9F GRADED SITE(S) THIS IS A LIMITED TIME PERMIT Coi
Gi ALL WORK AUTHORIZED MUST BE COMPLETED BY
TIME LIMIT
EXTENDED TO BY '
.. EXTENDED TO - BY 's c
CHECK IF SUPERVISED GRADING INITIAL DATE INSPECTOR'S SIGNATURE`
°SIGNATURE �/ GRD PREP
OF APPLICAL �( COMPACTION /I Q� I r
TE _ �J REPORT RECD 14
'ADDRE j. )x7fs 2 / SUP ENGR'S �� -
CERT RECD
IHEREBY ACKNOWLEDGE THAT 1 HAVE REAWTHIS
APPLICATION AND- STATE THAT -THE ABOVE IS- ROUGH GRADING
CORRECT AND AGREE TO COMPLY WITH ALL COUNTY APPROVAL *// , V
ORDINANCES AND STATE LAWS REGULATING EXC`A- PLANTING AND
VATING AND GRADING - IRRIGATION "
SUP ENGR'S e
SIGNATURE OF FINAL CERT
PERMITT "0i FINAL f • I •
APPROVAL
AGENT FOR . - SURETY BOND (�?/ le
I RELEASED {
ADOREss P C Fee$ 4 Permit Fee O
CUBIC YDS
,HAND Issuance Fee "
►• Total Fee 17
PLAN CHECK VALIDATION 'CK M o CASH I C: =P"MITT VALIDATION CK M O CASH
_
0- 0 0 .rte` :t-
7- 9 CH