HomeMy Public PortalAbout5548 WELLAND AVE_Grading__ APPLICATION FOR GRADING PERMIT
7iP641V-CE8078 12-75 S
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ADDRESS
SITE
ADDRESS.5,Y4,f.
2.4,9^0 191"'45 LOCALITY
NUMBERS BLOCK NEAREST l/ {
CROSS ST.
TRACT # ry I DISTRICT NO. MAP NO. STATE HWY. ,PR SS BY
NUMBER .3rJ/�UG//' �y'� _ /L
OWNER r/;F.�'/vJ� 6J94JIL)30A CIAL YES i]� NO'
US E SPECIAL
MAIL CONDITIONS
ADDRESS
CITY t1F.72V AW CITY NOLO
-'11""STATE .7�••y
ENGINEER c*91Z,&C45 s/� �' —REG..y No. �/ 00
ADDRESS .f 37� 114WI1Ajo71OIJ !/rr -
SURETY $ BOND
h TE'L COMPANY
C 1 T Y % pxir/7%A % ��i� N O. J`
GRADING TEL'. DATE RECD.
CONTRACTOR NO. O FILED BY y.
Z ��� t(/Qtprj CASH p p RECD. DATE 71.
ADDRESS Q; 6, DEPOSIT$./ (� BY FILED; CD
PROPOSED USE OF GRADED•SITE(S_)1 THIS ISA LIMITED TIME PERMIT o
C'_r%J,JA[7/9rN%dd f��j�L�L�P/�JL Jv)
ALL WORK AUTHORIZED MUST BE COMPLETED BY W
••TIME LIMIT: z
EXTENDED TO: BY:
EXTENDED TO: BY:
CHECK IF SU PERVI, D GRADING DATE INSPECTOR'S SIGNATURE
INITIAL.
SIGNATURE P, GRO.'PREP. '
OF APPLI CA T COMPACTION i
/ �✓ A •r/_. TEL /1„/1� ..�-q REPORT RECD, p� ,yawns a
ADDR S NO. �e ( V BUP. ENGR'•S, d
I HER Y ACKNOWLEDGE THAT 1 HAVE READ THIS CERT. RECD.
APPLICAT N AND STATE THAT THE ABOVE. IS ROUGH GRADING a01�
CORRECT AND AGREE TO COMPLY WITH ALL COUNTY APPROVAL IxP'i'
ORDINANCES AND TATE LA�S/REULA TING EXCA- PLANTING AND
VATING AND GANDI IRRIGATION
BA
SUP.ENGR'S. '
SIGNATURE O FINAL CERT.
PERMITT FINAL
!7I APPROVAL
AGENT FOR SURETY BOND
• RELEASED
ADDRESS c L� ~ - P:C. Pee$ J-/ 0 Permit Fee
HANDLEDS� , ' Issuance Fee
1
• I ro -.I-- Total Fee
PLAN CHECK VALIDATION CK. M.O. CASH "PE1UTNALIDA�N CK. M.O. CASH
0
oz.s o.c►o � c
cd i,
0 0 0 �.
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