HomeMy Public PortalAbout9700-9702 LONGDEN AVE_Grading__ APPLICATION FOR GRADING `PERMIT -
78A64f V CE807B 12-75
BUILDING AND SAFETY DIVISION 7/y
FOR APPLICANT TO FILL IN AIDDRESS '70
SITE ?n
70 GN V
ADDRESS LOCALITY
NUMBERS BLOCK NEAREST.
CROSS ST.
TRACT ��r / DISTRICT NO. MAP NO. STATE HWY. P C SSED BY
NUMBER JJ 46
,571.64
A jf YES (] NO
OWNER J ,MAIL ••��// /J �yJr/ USE�ZJ)NE SPECIAL NDITIONS
ADDRESS �/G(G 74FIVPZO`1l! &JJv �pp V�jC�/
CITY . i P C NOL'
ENGINEER el.ewr T NO,, .6964 n
SURETY $
ADDRESS 1047 E, LAS �iy9SQ i BOND
TEL. �,�/ SURETY
CITY SQA NO. �I-J�75 COMPANY
GRADING TEL. DATE RECD.
CONTRACTOR el_NO. P " FILED BY
ADDRESS G_&- • lff• /L.: /-3/ � BYC-D DATE
LEDEPOSIT•$ D
PROPOSED USE OF GRADE SITES) THIS IS A LIMITED TIME PERMIT fcF
Q ALL WORK AUTHORIZED MUST BE COMPLETED BY W
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TIME LIMIT: z
EXTE14DED TO.: BY:
EXTENDED TO- BY:
CHECK IF SUPERVISE ADING INITIAL DATE INSPECTOR'S SIGNATURE
SIGNATURE •/ GRD. PREP.
OF APPLICANT ` COMPACTION
-pJ 7EL. REPORT RECD.
ADDRESS :a, 0 0. �,-? / SUP. ENGR"S.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS CERT. RECD, A
APPLICATION AND STATE -THAT THE ABOVE IS ROUGH GRADING p 4°�(�'
CORRECT AND AGREE TO COMPLY WITH LL COUNTY APPROVAL `•P!
ORDINANCES AND STAT LAWS RE U TING EXCA- o-
VATING AND GRADIN PLANTING AND
)) IRRIGATION
SIGNATURE OF - �� d� ✓ FINAL CERT
PERMITTEE FINAL
/r1�� /]'/� t APPROVAL a
�L' Y e"'r�� SURETY BOND
AGENT FOR RELEASED
ADDRESS /E'lnC �rI� P.C. Fee$ �� Permit Fee �•
CUBIC YDS.
HANDLED: Issuance Fee 0-o
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Total Fee P • LI
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION` 6. �m.-,d:- C SH
Z L p CD ..1113 .%10 1 i
p �7 Q :) C
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