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GRAÐING PERMIT
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ALL UNUNES ]I,IUST BE TOCATED PRIOR TO A]UY GRADITTG
rd üd lrrdcr¡tad lttc ilor¡oe and Gcrrificelkn .boË æ tlCl æ
which is correct and accurate to the bcst of my knowledge.
Pdntand Sicn fhe
¡¡r adtroriæd aSpnL lf the rE¡r¡ù¡re bebl i6 not tt!¡t of ttro Ormer, a *preùe ktter of etfifiot¡ty, t¡¡grted bY råe
ûser, rnust be gu¡ded ryt¡h Útll åppüøion
Ldâæ, AËuiHirgPermûtcan¡rotbcics|¡edritåqnnroofoftqnlend&¡¡ee¡ccessorhegsncrrybr
purposes of inspcctions bV úe EulH-trg Divß¡¡on-
qtçr ftmü?, ilultþle separau perm¡t¡ nr¡y be requ'¡¡ed: f 0 St¡e Elccuical FermB {2f County (}li¡fS Fermt
f3) a¡rdrer pcrmit rêqu¡r€d for use on the property ider*¡fied ¡bo¡e, a¡. Strte or Gornry Higùu¡¡V/ Ro¡d Ácæ¡o or
a ffi tl&rffir XX¡char:P kmit
Ufln qlfr. A8uiHingPennfiþmesnu¡l¡r¡dyo*'ifÛeu,orkar¡tlrøizedi¡notcornmer¡ednÛtlrinlÐdrytof
dred¡æof ,issr¡¡næ¡ndlf ryortb¡u¡peadcdoróardonedÍor¡ periodof 180 daysafteroomrnencctnåñt
ft¡üratv. Ihb rpplicefron for a üuiHiry $ermit ûl¡¡st be lilnêd try üre ourner düre property, fucdbed aboË, or
I herebycerlifu rttatl hæ read this APpficalion ard üÞtdæ
ürdeßterd tå*ttæ tuiHirgDivisbn eænrtstt* Appli:ation, alorgrÈÉrtheplars a¡dspeciÊcafions¡nd cths
d¡t¡ ¡ubrnig¡l þ nre or on rny bCnlf {¡r¡bmûnabl, üaged ryon my erlfficaüor¡ a¡ to aæiläcy. åscumirg
complenenæof the subminaband approral.of ttr¡sÂpgfic.tion, a BuiHirgP-ertritwillbe i¡¡ued*r¡rtftg
perm¡srirnb mç¡ asO{,nêr, þ@nsguctûresüfircß¡nds) ardfacilithe dctailedont{æ $¡bmitteb reuisred bYthe
tü¡Hi¡g DtuùSon. ln ænsideratian of l{re i¡q¡¡ne d úre &¡¡Hllu Permit l .g[Eê tb* l end nry 4ents will æmf,y
a¡¡th pro¡4¡¡gmof anylcderal, sutc orlocrllm rçgr¡l¡t¡rgthcu¡o*and the Garfreld Gounqr &liHingûodç,Oì|VTS
rcgulrtbnsand apptiable H use rstul¡ti(mr (CsmV Regula¡ø{sD- t adñouddgeÛ¡tüc BuildrgFümft
nrry be rusperdod or rer¡gfted, upo¡ notb fiom the f.ot rdy, if thc locatim, oorlstruÉtion or use of ¡*re ¡fr¡ct¡re{¡f
erdfecifity{irs}, described ¡boæ,.¡re,nøt¡n ßonplianærlÈttr f-oünqRgt¡l¡t¡onlsl orsny other¡pplic¡bhl¡.w-
I heEùyg¡ant germission to tlæ 8r¡¡H¡ng Divúúon to eñterüË property, deccribGd sbovq b ¡n¡pecf dÈ stork I
furtf¡erack¡odedgetfutfie is¡anæ of tfte B¡¡H¡¡gpermitdocs rtot prsneñtthe h¡¡Hingffiblfrpm: E)
rpqr¡i¡i¡g trfie æaection of crrors in tlre a.rbmittalr, if any, di¡coue¡ed *er iseumcc; or {2) stopp¡rg @rlttrl¡ctfo¡rl
r¡r u¡e of üre stn¡ctr¡re{¡l or fadlity{¡ee} if ¡¡¡dr ¡s ir vioþt¡on of Cd¡rdy Fqslatftrn(s} or any otüer ¡ppfi¡t¡b tnr.
Rg¡riewgfthirÄppfç¡ùblr, ¡ncludirgssbmitt¡ls, and ¡nspect*¡nsof $erlorkbyt$e tuiHitgÐividondot¡ot
constit¡¡þ an acoeptance of ,r?spon¡rt¡lity or liab¡l¡ty Ð tf¡e Gounty of error+ onri¡c¿on¡ or dis¿Yapanc-c¡" ås tf.re
Or¡¡r¡er, I ads¡olkdgeüret re¡podbilityîorænpüanceriÚt fuderel, staÈand local l¡ss¿rd CoüntyRq¡¡l¡dorË
agerËr, lrdudirg nithout limitation rny arcldb* desþner. erg{neer z¡d.l s
inforrmatk¡n conbined aboræ is true ard onrr¿ I
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