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Application - Grading Building Permit SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 1810 E HAZELTON AVENUE,STOCKTON,CA 95205 BUSINESS PHONE(209)46&3123 REQUEST FOR INSPECTION PHONE(209)468-3165(24 HOUR RECORDER) THIS SECTION IS TO BE FILLED OUT BY DEVELOPMENT SERVICES.STAFF. SITE LOCATION INFORMATION �j ✓ Technician: Date: (_ - -0 Job-Site Address: 57' �/ v f /!a'/L APN: W) • 3 Cross-Street: City: ZIP: Precise Location: C. o i 0 Q THIS PORTION OF THE APPLICATION MUST.BE COMPLETELY FILLED OUT BY THE APPLICANT IN TO APPLY FOR.PERMITS REQUIRED.TO GRADE PROPERTY IN SANJOAOUIN COUNTY Scope of Work: -rE r= Y/F rr S . f• F ..x .t.+o nJ Number of Cubic Yards to be moved: OWNER NAME AND ADDRESS APPLICANT NAME.AND ADDRES Name: 'I//XmicG lI� ,IGH -r Name: r"oti+ Sr re-+.-T/ +r- 2185 Address: (0 4- e j 0 p t IG /N �, Address: o -(/L/Y/S T�LNN City: S,4N J oSE state: Gp City: vE.crlo�E state: ZIP: S/7D Ph:(4cO 467c- ZIP: ¢$'.Sd Ph:(t/Z ICI7- Z7 ac CONTRACTOR INFORMATION Ph:(9,Z-� 47- Z^DO Lie. No: 790 5 7 Company Name: `3 Er4 n 0 N S Kca c-'r J Address: o ,3G \Fns �.-rr cry C, 5r0:/"F -- City: V _ o�F St: ZIP: ySu .ENGINEER INFORMATION Ph:(774 3,Z-5 -o -Z, Lie. No: �f- ro3 Company Name: o N °.�� e N el r--A=t✓+'a-r"= ` =�-+ N T r t r Address: P 5 ur✓IgS �rz-c"r. �..i.rr^- City' <No SI:/JV ZIP: FACILITY INFORMATION Water Supply Existing On-Site Well: New On-Site Well: Public: Sewage Disposal Existing Septic System: New Septic System: Public: Storm Drainage No Change: I/ New On-Site System: Public: Driveway/Access Existing Driveway: t/ New With Curb-Gutter: New Without Curb-Gutter NNN WHO MAY APPLY? ONLY THE OWNER OF THE PROPERTY OR A LICENSED CONTRACTOR MAY TAKEOUT BUILDING PERMITS- Owner-Builders must submit the following with their application: A property iax statement or a recorded deed - A completed and signed"Owner-Builder Verification'form A completed'Authorization for Application'form if other than the owner applies. Contractors must submit the following with their application: Current license numbers and a worker's compensation insurance certification (this is not necessary if this information is already on file with the Department) A waiver form if the contractor is not subject to worker's compensation laws A completed'Authorized to Sign'form If other than the contractor applies (this is not necessary If this information is already on Tile with the Department).