HomeMy Public PortalAbout5412 A & B MCCULLOCH AVE_Grading__ APPLICATION FOR GRADING PERMIT
76AGAIV-CE807B 1E-75
�V�—� BUI ING AND SAFE k.1,10N
FOR APPLICANT TO FILL IN ADDRESS
SITE
�Z�� VL; LOCALITY
NUMBERS 417-, Cr I-e, BLOCK NEAREST
CROSS ST.
TRACT r DISTRICT NO. MAP NO. //�� STATE HWY. P ES D BY
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, 0� TO V YES O NO
OWNER /y/fjF► G L.CGj U.S ZONE SPECIAL
MAIL / CONDITIONS
ADDRESS V ✓�j J
CITY �� !U NOLO
L _ P/1LL p� STATE
ENGINEER 1 REG. NO.
MAIL 1 r r BOND
$ 1 s�1-l. �ND
ADDRESS 3 G .h!d!✓i//✓CJ [S 1 (i O �� / 7
TEL. SURETY
CITY /) NO. �/��L� 43Jp S ET ,
GRADING TEL. DATE RECD
CONTRACTOR !� C,r4f/'�,swFlO. yry-- tlr7 FILED Y
ADDRESS�l� 572wr 121/04C /YL1tf3 .4 DEPOSIT$ BYC,D. LED p
PROPOSED USE OF GRADED SITE(S) THIS IS A LIMITED TIME PERMIT c
G� fT CGf!✓1>G� / ��' / ALL WORK AUTHORIZED MUST BE COMPLETED BY
LL
TIME LIMIT:
EXTENDED TO: BY:
EXTENDED TO: BY:
CHECK IF SUPE I ED GRAAIV INITIAL ��-
DATE _ INSPECTOR'S SIGNATURE
SIGNATURE
GRD. PREP.
OF APPLICANT COMPACTION
•A TEL. `� REPORT RECD. I
ADDRESS 9 NO. SUP. ENGR'S.
1 HEREBY ACICN LEDGE THAT I HAVE READ THIS CERT. RECD.
APPLICATION AND STATE THAT THE ABOVE IS ROUGH GRADING
CORRECT AND AGREE TO COMPLY WITH ALL COUNTY APPROVAL i I
ORDINANCES AND STATE LAWS REGULATING EXCA- PLANTING AND /
VATING AND GRADING. IRRIGATION
SUP.ENGR1
SIGNATURE OF t� FINAL CERTT..
PERMITTEE �r
APPROVAL
FINAL
AGENT FOR to SURETY BOND RELEASED
,
RELEASED l
ADDRESS f P.C. Fee$ Permit Fee C2/0
CUBIC YDS.
HANDLED:
Issuance Fee
300 ci'•Yds
Total Fee 0
PLAN CHECK VA�LIDATION CK. M.O. CASH PERMIT VA DAT DATION? CK. -Mlo' ?ABN
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