HomeMy Public PortalAbout8604 ROCCUS LN_Grading__ fi41TC- 0 7APPLICATION FOR GRADING PERMIT 1
9 '
COUNTY OF LOS ANGELES SITE
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION OCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST T
CASSATT D. GRIFFIN. SUPT OF BUILDING
CROSS ST. - /I �� / /
FOR A P I T O FI IN MAP NO. STATE HWY. JPROCESSf�D/ DISTRICT` 7.
SITE Ji_r!.'f / YESNO❑
ADDRESS _ - 1 '�-,� USE 70NE SPECIAL,
LOT Ny CONDITIONS
NUMBERS � 1'�t,f�l� fG.' BLOCK I
i
TRACT
NUMBER
x SET BACK YARD HWY. STREET NAME WIDTH
OWNER
MAIL ..� Yy_� -i FRONT P.L.
ADDRESS
TEL SIDE P.L.
CITY "���'-� _ _'- NO. -
_ STATE SURETY BOND
ENGINEER .�/) -'-,j(,- REG. NO. BOND NO.
�
SURETY
ADDRESS jJC �- -
*,{ _ �l�y.. COMPANY
SUP'V'G.GRA,, G. STATE DATE RECD.
ENG INEER ")f_ REG. NO. FILED BY
CASH RECD. �, DATE �..
ADDRESS DEPOSITS BY -L a� FILED
GRADING TEL.
CONTRACTOR NO. -
ADDRESS
DESCRIPTION OF WORK
r. ,I
CHECK IF SUPERVISED GRADINGol
SIGNATURE _
OF APPLI CAN %
ADDRESSa.:'1�.
NO.OF CUBIC YDS. HANDLED: - � A •> +.,..,7
P. C. s C d
FEE
FEE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS WORK TO BE COMPLETED WITHIN DAYS
APPLICATION AND STATE THAT THE ABOVEOS CORRECT FINAL CONTOUR DATE INSPECTORS SIGNATURE ts`
AND AGREE TO COMPLY WITH ALL COUNTY RDINANCES MAP FILED
AND STATE LAWS'rLATING EXCAVATING.A. D GRAD- FINAL CERTI FC. ..f �
ING. OF ENG R. RED. "�` � '�•'�'"�- (
SIGNATURE OF` / WORK ' DISTStICTRENGINEER -,
PERMITTE��" f{ COMPLETED
SURETY BOND
ADDRESS RELEASED
I
CLYDE N. DIRLAM.PRINCIPAL STRUCT RAL ENGINEER
PLAN CHECK VALIDATION cK. M.D. CASH PERMIT VALIDATION CK. fM.O. CASH
7470 - 21
j� 1 9 7 9- .JUL 3 0 9 0 A 2 0 0.0 0 "� E
`110 e.. A. T- JA1'9 8 0 JAL 3 0 4 A 15.50—