HomeMy WebLinkAbout07SA64IT•CE60712.73 APPLICATION FOR GRADING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN
51 T E
ADDRESS
NUMBERS OLOCKy
TRACT 1'I
NUMBER l 1
OWNER B1` �J�JTF�J:; F.. l,�.+'i',� :1✓i •-q
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CITY '. X:,4! lJ i 9. ?#w' TEL. r
STATED. r'Y
ENGINEER . lA."' y .+`.�" �' �' REG. Nm!��I
ADDRESS
SITE
ADDRESS
CP
FILED
LOCA OT
a
CR035 ST.
DEPOSIT $ BY FILED
CHECK IF SUPERVISED GRADING
THIS IS A LIMITED TIME PERMIT
SIGNATURE
DISTRICT N0. MAP N4D.
STATE HWY.
PROCESSED BY
YES (3NO
JSE ZONE SPECIALy
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HANDLED: ,','"+i tE'
EXTENDED TO: BY:
t CONDITIONS
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FEE ` ..`•'1
EXTENDED TO: BY;
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
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CITY .-.'1I"';Y r") AY - NOL. «�.f •. :,/gyp
GRADING TEL...
CONTRACTOR NO.
ADDRESS
PROPOSED USE OF GRADED SITES)
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'
SURETY$ BOND
OND NO.
COMPANY
CP
FILED
a
CASH RE C' D. DATE
DEPOSIT $ BY FILED
CHECK IF SUPERVISED GRADING
THIS IS A LIMITED TIME PERMIT
SIGNATURE
OF APP ICANT,
ALL WORK AUTHORIZED MUST BE COMPLETED BY
ADDRESSNO
TIME LIMIT:
CUBIC YDS^ + P.0 S t ()
FE
HANDLED: ,','"+i tE'
EXTENDED TO: BY:
$ t
FEE ` ..`•'1
EXTENDED TO: BY;
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
INITIAL DATE INSPECTOR'S SIGNATURE
APPLICATION AND STATE THAT THE ABOVE IS
CORRECT AND AGREE TO COMPLY WITH ALL COUNTY
Gqp, PREP.
ORDINANCES AND STATE LAWS REGULATING EXCA•
VA TING AND GRADING. i
COMPACTION
REPORT RECO.
SUP, ENB R'S,
SIGNATURE OF !W
"'r• a'_ J J/✓
CERT, RECD.
PE RMITTE '�
ROUGH GRADING
APPROVAL
AGENT FOR
PLANTING AND
IRRIGATION
JJ fA✓ 5.f',i e'✓ I ,p ':..,C.S
SUP. ENOR'S.
i ,J
FINAL CERT.
ADDRESS '� °i
FINAL
MAKE CHECKS PAYABLE TO.
APPROVAL
HARVEY T. BRANDT, COUNTY ENGINEER
SUETY
AELEASED0 ND
PLAN CHECK VALIDATION CK. M.O. CASK
PERMIT VALIDATION CK. M.D. CASH
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