HomeMy WebLinkAboutNo Permit Number (1300)APPLICATION FOR GRADING PERMIT
76A641T-CE807 12-73
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SADDITERESS
LOCALITY
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN ARTCROSSST.
SITEDISTRI.,,CT
ADDRESSIADDRESS NO, MAP NO. I I - I
STATE H*Y. I Yl
PROCLSSED By
NLUOT
MBERS BLOCK USE ZONE SPECIAL
CONDITIONS
TRACTNUMBER
OWNER
MAILDATE2) -, E. D I I \ I V,) AGENCIES REQUIRING CLEARANCE
CITY T_ V L L CL, -rO TrL - I
STATE
ENGINEER R EG. NO.
MAILADDRESSl_7'_7j) I L %il
TE
CITY
NOLO
GRADING TEL. NO. CONTRACTOR
ADDRESS I k
SURETY S BONDBONDNO.
PROPOSED USE OF GRADED SITE(S) SURETYCOMPANY
DATE
BYRECID.
FILED
CASH RECD. DATEDEPOSIT $ BY FILED
CHECK IF SUPERVISED GRADING
I THIS IS A LIMITED TIME PERMIT
SIGNATURE --
OF APPLICANT t7n\ . ALL WORK AUTHORIZED MUST BE COMPLETED BY
FL
ADDRESS TNo.-45 6-27. TIME LIMIT:
CUBIC YDS. -I.. P.C. S
HANDLED: 00 FEE V -. EXTENDED TO: BY:
EXTENDED TO: BY: IFEE
ILHEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPICATION AND STATE THAT THE ABOVE IS
CORRECT AND AGREE TO COMPLY WITH ALL COUNTY'
INITIAL DATE INSPECTON'S SIGNATURE
C RD. PREP.
COMPACTION
REPORT RECD,
ORDINANCES AND STATE LAWS REGULATING EXCA-
VATING AND GRADING.
SIGNATURE Or
PERMITTEE
SUP ,NGR:S
CERT, RED. D:
ROUGH GRADING
APPROVAL
AGENT FOR
PLANTING AND
IRRIGATION
FINAL
ADDRESS
SUP. ENGR'S.
CERT,
FINAL
APPROVALMAKECHECKSPAYABLETO.-
SURETY BOND
RELEAS CDHARVEYT. BRANDY, COUNTY ENGINEER
FLAN t;HEC;K VALIDATION CK. M. 0. CASH' PERMIT VALIDATION CK. M.O. CASH