HomeMy Public PortalAbout9803 GARIBALDI AVE_Grading__ 7aA 664 R.D. 47 12• 2 County of Los Angeles
General Deposit i Road Department No. �2 A6 �
APPLICATION FORAfto
Special Deposit $ -- EXCAVATION PERMIT M Date 14 1 1
Mr. �✓ C �� R. D. No. 1a
(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 Ordirt&nce 3597 as amended of Los Angeles County.
For Purpose of
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Length and width of excavation h+ 010'e0o
�/'�"
If pipe is to be laid, state size and kind— / ! ; - -- ---- -
Name of Highway 4nd designatio ,location, SH WIN NP OF SURFACE TO BE CUT
r
-- - _. A
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 officer 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 topt
all of said,lin ''ties are hereby sumed 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 pub c, it mus ov elocated, as designated,by the Road Commissioner, at the expense of the permittee or his successor in interest.
Signed Telephone o.,��' Z° 6
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Applications Must be Made in Duplicate. Issuance Fee ($1.25) and Deposits Payable in Advance.