Grading Permit Application

Town of Indian Head
4195 Indian Head Highway
Indian Head, MD 20640
301 743-5511 PERMIT NUMBER

Grading Permit Application
SOIL CONSERV. DIST. NO. DATE ISSUED

DATE ISSUED

GRADING SITE ADDRESS PHONE NO. Application is hereby made for a permit to execute
grading operations as described below
below.

DESCRIPTION
DESCRIPTION OFOF WORK
WORK

OWNERS NAME AND ADDRESS PHONE NO.

STRIPPING-STOCKPILING-TEMP, EROSION CONTROLS TO BE
STRIPPING-STOCKPILING-TEMP.
ACCOMPLISHED BY

ROUGH GRADING
TO
TO BE
BE ACCOMPLISHED
ACCOMPLISHED BY
BY
ARCHITECT OR ENGINEER’S NAME AND ADDRESS PHONE NO.

FINAL GRADING-PERMANENT EROSION CONTROLS
TO BE ACCOMPLISHED BY

FINAL
FINAL SEEDING,
SEEDING, SODDING,
SODDING, PLANTING
PLANTING
TO
TO BE
BE ACCOMPLISHED
ACCOMPLISHED BY
BY
CONTRACTOR’S NAME AND ADDRESS PHONE NO.
OTHER: (IF ANY)
TO BE ACCOMPLISHED BY

I have carefully examined and read the above application and
know the same is true and correct, and that in doing this work, all
INTENDED USE OF STRUCTURE (BE SPECIFIC)
provisions of the Code of Ordinances, of the Town of Indian
Head, Charles County Ordinances, and Laws of the State will be
complied with, whether herein specified or not.

______________________________________ ________________
EST. CONSTRUCTION COST EST. CU. YD. MATERIAL PERMIT FEE SIGNATURE DATE

FOR OFFICE USE ONLY
CONDITIONS (IF ANY) AGENCY DATE APPROVAL DENIED
PLANNING COMMISION

SOIL CONSERVATION
DISTRICT

DEPT. OF WATER
RESOURCES
TREASURER’S VALIDATION
PUBLIC WORKS

DEPARTMENT OF
INSPECTION

ZONING

PLEASE MAKE CHECKS PAYABLE TO THE TOWN OF INDIAN HEAD
CAUTION
TO BEGIN CONSTRUCTION BEFORE A GRADING PERMIT HAS BEEN ISSUED
IS A VIOLATION OF THIS ORDINANCE ____________________ _____________
Approval Date