HomeMy Public PortalAbout6101 CAMELLIA AVE_Grading__ 76A 664 F.D. 47 (Ab 12-53 County Of Los Angeles
General Deposit Road Department No.—_.-
r APPLICATION FOR Date
Special Deposit —_ _--___ _ EXCAVATION PERMIT —
R. D. No. � -------
(Please print name)
hereby makes application for permit to excavate in the Public Highway at the following described locations, subject to the
provisions required by Ordinance 3597 as amended of Los Angeles County.
For Purpose of —
Length and width of excavation-----_. ---
If pipe is to be laid, state size and kind - ------ --- — --
Name of Highway and designation of location, SHOWING BIND OF SURFACE TO BE CUT—__
All pipes to be at least two feet below gutter grade of highway--.----.
Give Franchise Number or other right to occupy the highway for this purpose_ —
In consideration of the granting of this application, it is agreed by the apppplicant that the County of Los Angeles and any offleer or employee thereof shall
be saved harmless by the applicant from any liability or responsibility for any accident, loss or damage to persons or property, happening or occurring as the
proximate result of any of the work undertaken under the terms of this application and the permit or permits which may be granted in response thereto,and that
nal of said liabilities are hereby assumed by the applicant. It is further agreed that if any part of this installation interferes with the future use of the highway by
the general public, it must be removed or relocated, as designated by the Road Commissioner, at the expense of the permittee or his successor in interest.
Signed _— —__ ___ Telephone No. — —
Mailing Address --
Applications Must be Made in Duplicate. Issuance Fee and Deposita are Payable in Advance.