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HomeMy Public PortalAbout9831 GARIBALDI AVE_Grading__ 76A 664 R.D. 47 12-32 County of Los Angeles General Deposit $ '' " ' Road Department No. APPLICATION FOR Special Deposit $ EXCAVATION PERMIT Date :771- (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 excavatio n��— If pipe is to be laid, state size and kin — — '' Name of Highway and designation of location, SHOWING BIND OF SURFACE TO BE CUTT��--'�'"��""' go 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 respon§pthereto,and that all of said liabilities are hereby assumed by the applicant. It is further agreed that if any part of this installation interferes with the future u6Lrof the highway by the general public, it must be removed or relocated, as desi ated by the Road Commissioner, at the expense of the permittee or his successor in interest. Signe '�`~" Telephone Nod! Mailing Address '-+� -� R f t-% 5-7— � � f Applications Must be Made in Duplicate. Issuance Fee ($1.25) and Deposits are Payable in Advance.