HomeMy WebLinkAboutNo Permit Number (1292)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
PROCESSED By
NLUOT
MBERS BLOCK USE ZONE SPECIAL
CONDITIONS
TRACTNUMBER
OWNER
MAILDATE2) -1 E. D I I \ I V,) AGENCIES REQUIRING CLEARANCE
T V L L CL-rO .TrL
CITY .. - ,
STATE
ENGINEER R EG. NO.
MAIL
ADDRESSl_?'_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 (J— TIME LIMIT:
CUBIC YDS. e i.
HANDLED:
P.C. S00FEE 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
GRD. PREP.
COMPACTION
REPORT REV D.
ORDINANCES AND STATE LAWS REGULATING EXCA-
VATINGAND GR IAD NG.
SIGNATURE Or t , , ' ?., j.) I , ..
PERMITTEE _l__
SUP ENGR:S
CLRi. RED. 0:
ROUGH GRADING
APPROVAL
AGENT FOR
PLANTING AND
IRRIGATION
FINAL
ADDRESS
SUP. ENGR'S.
CERT,
FINAL
APPROVALMAKECHECKSPAYABLETO.-
SURETY BOND
RELEAS CDHARVEYT. BRANDY, COUNTY ENGINEER
FLAN CHECK VALIDATION CK. IA. 0. CASH' PERMIT VALIDATION CK. M.O. CASH