HomeMy Public PortalAbout10553 LYNROSE ST_Grading__ .=AGJIT.CE1)07 APPLICATION FOR GRADING PiRml '
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COUNTY OF LOS ANGELES ASITE
DDRESS
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER -- j
F
SATT D. GRIFFIN. SUPT OF BUILDING NEAREST
CROSS ST.
R APPLICAZIT TO FILL IN MAP NO. STATE HWY. PROC�ED DISTRICT NO
YES❑ NO❑ BY 1/1 /C/1,�,✓^�l� � USEZONE SPECIAL i!j y �, 1 CONDITIONS r i I f. (�y BLOCK
�'-1SET BACK YARD HWY. STREET NAMF EXIST.
WIDTH�1{CST' DelveMAIL
�_ + T FRONT P.L.
J 4 L
TEL.
SIDE P.L.
CITY �' C n NO.'
STATE SURETY BOND
ENGINEER `Ty]j Cr,,-.St 1-: REG. NO. "� 'J BOND NO.
SURETY
ADDRESS'',� Sfj-jta (���- « r COMPANY
SUP'V'G.GRAD'G. STATE DATE RECD.
ENGINEER REG, NO. FILED BY
CASH RECD. DATE r
ADDRESS DEPOSIT S BY FILED
GRADING ^+. TEL. -
CONTRACTORNO. i
ADDRESS -
DESCRIPTION OF WORK
n. of }
CHECK IF9bPE IS GRADING
SIGNATURE
OF APPLICA
ADDRESS_ _NO,OF CUBIC YDS. HANDLED:
P. C. S V
FEE ol
�-)0 -,i 11� FEE g �.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS WORK TO BE COMPLETED WITHIN DAYS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FINAL CONTOUR DATE INSPECTORS SIGNATURE
AND AGREE TO COMPLY WITH ALL COUNTY OR INANCES MAP FILED
AND STATE LAWS RFjG�OLATING EXCAVAT, G NO GRA
D- FINAL cERTI v.
..� _ / OF ENG'R. RECD. / `J
SIGNATURE OFC y ./J/ WORK �. DISTRICT ENGINEER
PERMITTEE .�- [ ��/66LLLLL�� COMPLETED
SURETY BOND
JADDRESS RELEASED
AL CLYDE N. DIRLAM, PRINCIPAL STFrllCTURAL ENGINEER'
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. %M.O. CASH
MA
5832 � .C�EC 7 1. 8 D 5.0
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7 3 5 8 1 JAN P 3 4 D 5.0 0