Loading...
HomeMy Public PortalAbout5551, 5553, 5557 ROSEMEAD BLVD_Grading__ Tew..I v-c¢e.TW ,[-,. APPLICATION FOR GRADING, PERMIT BUILDING A SAFETY DIVIS FOR APPLICANT TO FILL IN SADDRESS3:25 -/5S77N , SITE SS / ADDRESS ,7 . LOCALITY NUMBERS S BLOCK NEAREST CR049 9T TRACT / DISTRICT NO MAPNOSTA E HWY R ESS BY NUMBER ' UB oZOO6 YES NO t OWNER E ZONE SPECIAL MAIL P.D. 80 CONDITIONS ADDRESS ^- 17AV O /I� TEL CITY C./� Ir'f.r •.�• NO / e• r�L• STATE EN OI HE ER6 y REO NO MAIL ' SURETY $ • p AODR ESS aa BOND CITY 4W NOL ���� Qy COMPANY ORA DING TEL DATE C'O CONTRACTOR NO FILED BY 'pp ADDRESS _ DEPOSIT PATE FLED O PROPOSED USE OF GRADED SITE(S) THIS IS A LIMITED TIME PERMIT Go] 5 ALL WORK AUTHORIZED MUST BE COMPLETED BY TIME LIMIT h z EXTENDED TO BY EXTENDED TO BY CHECK IF SUPERVISED GRADINGNIAL DATE INSPECTOR'S SIGNATURE 916NATU RE ORD PR[P OF APPLICANT E COMPACTION �7 ADDRESS NOL •! REPORT REcD / 3-2zt 3 !OP ENOR ! I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS CERT REC D APPLICATION ANO STATE THAT THE ABOVE IS ROUGH ORADING CORRECT ANO AGREE TO COMPLY WITH ALL COUNTY APPROVAL ORDINANCES AND STATE LAWS RE GULATtNG EX CA- VATING AND GRADING PLANTING ANp IRRIGATION SIGNATURE O !UP EN*R's PERMITT IINAL C[RT - IINAL APPROVAL AGENT FOR/-ftSURETY [ONO _ RELEASED ADDRESS • P C Fee S Permit Fee CUBIC YDS HANDLED cl 7d Issuance Fee Totel Fee PLAN CHECK VALIDATION M 0 CASH PERMIT VALIDATION CX M 0 CASH 163rZMAY- 918 ® 270.00 69b -923P4AY 25 4 0 270.00 �sd