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Page 1 of 2 Application Form – City of Albany Grading Permit The Applicant Shall Complete All of the Following Items: 1. Date of application: 2. Name and address of Applicant: No. 3. Location of grading site: 4. Names and addresses of New York State Licensed Surveyor and/or Professional Engineer responsible for the preparation of the site plans? 5. Total land area to be effected (acres): 6. Total volume of cut areas (cubic yards): 7. Maximum depth of cut (feet): 8. Total volume of fill areas (cubic yards): 9. Maximum depth of fill (feet): 10. Types of soil and depth of each type: 11. Location where cut material is to be delivered: 12. Does the property owner receiving the cut material have a Grading and Mining Permit for the fill site? (If cut material exceeds 50 cubic yards, then attach a copy of the City- approved Grading and Mining Permit to this application). 13. Average depth to groundwater (feet): 14. Is the site subject to slides or inundation? If yes, then briefly explain on a separate page and attach an Engineering Report describing the condition. 15. Name of stream to which site is tributary to: ---PAGE BREAK--- Page 2 of 2 16. Are there any natural watercourses to be relocated, modified, or piped? 17. What is the maximum slope of the existing ground (percents): 18. What is the maximum slope of the finished grades (percents): 19. Are butress fills to be used? . If yes, then attach a copy of the design calculations to this Application. 20. If fill is to be imported to the site, then provide the source of the fill material and the routes to be taken by the trucks from the source: 21. The Applicant shall attach to this application the following information: Soils Report ( 2 copies) Site Plans (5 copies) Easement Agreements (2 copies) Permit Fees Performance Bond To the best of my knowledge, the information contained in this Permit Application is true and accurate. I have read and understand the provisions of the Grading Ordinance of the City of Albany, and I shall comply with said Ordinance. Signature of Applicant Applicant’s Name (Printed) Title or Position Date Information To Be Completed by the City of Albany Engineering Division: Amount of Bond: Term of Permit: To: Dated this day of Approved: City Engineer