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HomeMy WebLinkAboutZC 151; THE CAPTAIN'S ANCHORAGE INC; Zone Change (ZC)'. k\ ,·. ·, !·< ~ ' ":'c, ,,, CITY OF CARLSBAD APPLICATION FOR CHANGE OF ZONE AS PROVIDED FOR·IN CHAPTER 21.52 OF THE CARLSBAD MUNICIPAL CODE DATE J-QQ-7~ / ZONE CHANGE NO. ~~ .:.-~5' I (Fo~ Official Use) FILING FEE RECEIPT NO; c:;2C)~ *******~********************************************************************************** I. I I. A REQUEST IS HEREBY MADE TO RECLASSIFY. PROPERTY DESCRIBED AS: (Exact Legal Description) 1-oT 3, 4) s [3L k Cb P&LlSADE.S GLfc. G CB-~LSfflf)D . I CA From C-I . to Q.-~ (exact zoning classification) ---,-(e_x_a-ct.,.--z-on_,i,_n-g-c""""l-as-s--..i-=f,.,--.c-a-:-t1..-.o-n~)-- by_amending Title 21 of the Municipal Code 6f the City of Carlsbad. THE PROPERTY DESCRIBED HEREIN IS ADDRESSED AS 2R78 CAR~ GAD ___,_f3.;;...t_lL=-v-=--o....;;:· =-· _____ and is located on the ......---.'E_·· -A--'--S;=-'-=' ..__\ -------.-- (North, Sou th, East, West) side of ~~ ~Lstr?et~"J D B}JJf}etween (Na:f~C£?re~t? B~K 8 s.u wooo s-l s, . (Name of Street) LU '6. the undersigned state that Wt A 'R. fL ( I, We) ( I am, We are) the Q W \\J ~ Q,_ ~ of the property described herein and hereby ( Owner, Owners give OUR (My, Our) authorizatfon to the filing of this application: Name F-Rf\Nrr. -e: ')\JO.VA k (Typed or Printed as sh wn on Recorded De ) and Signature~~~~--==ll6--9~+--~-P.-.P.~-.ie--1------,-----'------ Name -.-l'--.....1--:---'---->,;,<.-=--'---'"--+-=-'-..,.__,,'""-""'--'--"~,---:--:--=---:-'r---------- S i gnat u re -Y--+--4-'&...4p:::lo.a--,:z.._-...;~-=--'"...::;_•~~~:::..:;4~· ..,_..·...,,_ -/ _____ _ -1 - . ;O APPLICATION FOR CHANGE OF ZONE· Name --rc=-Ty_p_e...,..d -o-r---=p=-r-=-i....,nt,-e-=-d-a_s_s.....,.h-o-wn--'-o-n-=R=--e-co_r__,d-ed~D-ee_d,.....l ___ ......... ..,........,_...,...,......_. __ _ Signature __________________ ,...___,,....,._,_,_ ___ _ Name --r:(T.:-y-p-ed-.--o-r -=p:--r-:-i n-:t-e-.-d _a_s_s-:-h-ow_n_o n--.:R,--ec_o_r-=-de-d~Oe_e.....,dr.-) --. ............ ~......,...,.---- 51 gna tu re -------------------------- Name -_-.-(=Ty_p_e-:-d-o-r-,P=-r-'-:-i-n t=--e-:-d_a_s----:s h-o-wn_o_n--=R=-e-co_r__,d,.....ed-:--=D-ee_d.,...,.)---------- S i gna ture -------------------------- III. THIS APPLICATION FOR A CHANGE OF ZONE ON THE PROPERTY DESCRIBED HEREIN IS SUPPORTED BY THE FOLLOWING REASONS: 1. SUCH a zone change is warranted because 'I..T l S p RF'.% i:2tvT L ¼1 A HAVY\ 8u ·RG 8Q ~13..S'TeuQeN'° AND W'Du1...Q 00 Ar) E;<-c \'S'.-LL.'~rv '\ . Lac An QY\) Fo ~ A Se &Eoao fH'\10 ~~&k..):{.ao.sr.:;__ T:'(pa ~G:~\"f)Utl&N:t= W\'Y~ et c;=>N SA-Le. l1@ ~lQ...@ 2. SUCH a zone change will be in the interest of futtherance of public welf~re because ::I::I \;-s LDC.Ate D A-T A W\ A J:OlR, A RTE:,,A, \'AL C?..oLl t=C...T6R s-tRe.,e. T Fo·R. E-A-SO . \ (-\c.CL ~s~ FoR C.u.sto\/v\ E.RS- 3. THE permitted uses in this proposed reclassification will not be detrimental in any way to surrounding properties because lT \ S S'l '7v't I LA-~ I TO ex l ~Tl NCa U £E: S <0F :ttlS ~ulf.?,QouNDi'.Y\1Co ? \\o PE: AT y. · 4. THE property in this application is more suitable for the proposed zone than the existi'ng zone because ~ F \TS • Loe A-r--r-1 0 V\) N EA-~ • =:D::tc ST· A-1'z Ba Ac.. i::\ . Tt/-E {)Q o ~ Ee ,y \ s Now-e \':}AW\ 8u RC68R \?~SJ:i:hJRANt ANO tl As ,N :n±~ f)f\s't' SE('<\25.D ON Sf)Lc 8£2R .. 5. WHAT were the original deed restrictions, if any, concerning the • type and class of permitted uses on the·subject property? (Give expiration date of these restrict ions) --~"---'-..... O____..\\) ___ ·...,.c.,~..-.-,-. ___________ _ -2- 'APPLICATION FOR CHANGE OF ZONt 6. THE adopted General Pl an of the C_i ty of Carlsbad recognizes the use of land. -------------------0 PT ION AL----------------------------THE FOLLOWING SPACES ARE FOR SIGNATURES OF OWNERS WHOSE PROPERTIES LIE WITHIN A RADIUS OF 300 FEET OF THE PROPERTY PROPOSED TO BE RECLASSIFIED AND WHO APPROVE OF THE CHANGE. (attach extra sheets if necessary) _., NO. ON MAP NAME ADDRESS LOT BLOCK TRACT la%-;.,-::S ~r,-·M~ E.. --t. S'7cz~ ) d..5 ¥' C.L.~~MDN'l ' l;I 9.0 O I l 8.06 INi (:)GAO OR ~A-'N "u\\~Gn ~'l1I" l-'J..-'3 . -~ -~ 5.E.~ \J\"t:u.) C.oNOO ~ 701 De.LA-MAR. F\\\lAC1'¼-I ,.. 1-/.S Co 0 .l l ~ob l?-1.0 ~W\l'Nb O~t..~10 N ilf51it-"'--i..f 7 bSb'"6 Bc:u.. B.,c:.~(<.L-SI~ F,Q _/ Ol 1 ?_ a b \4 tTR A..l1 V "T'O D.D . (.U,-..;, . 7 AU 8... C::::. G. Q'"2.. 1 \\ '4 ~ PAUL~ OORH\16 lS''.2. Sg(:;.>V D,F) ~Af ~ CJ I \ '2 {) 6 'R \.) R h) e_~ru.s • 1 ' 9 0 I J '206 q ~ ~~ F frR R E l. H::>CJ SE©uD1~. g .'f'I c.A-R_l.S l /::j. 10 G:>v"S.Tu F ~ ~&C'J 13 L~-.. h\cN~ oa. -~,c.. tO 0 \ 1 ?-CJ6 KA.~ 0 1 \Vt~ K C2..A-R.L~ G!na \Lf YnA-~f t,i\ J3 R \12.R. L..!/ '3'1H GAR.~l6'.L .. ~ ' L{ ~ 11 ?.Ob C,.A--A l£ C3A-0 . - 15 0 f),(-) f~ HoweL. -gq 6-S--GA-fc. F, \3. 1.... n \~ o 11 2. 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Of!.{· ~J.L.~8BC • JO 1 lt..f·l~ )b· C.\4A{~l$.~ B, if \Jl bLI ~\' 3S'ti"2...CAIJ,L~BA-'D l·-?_-)o, J....~ 3 "2 o'-{ A l..c! r-,c.;i::-;,A WOO!::) ~v o c..,~AL:~Rlt~ q'"2.oc &:> '?.. 0 \1 /.... U 1:-1 f-FN 'F REh'"'lli2.'( I DJ.;.. Vt\\ P,. 'A 'rY\ IA-(\. fl\~ IS1 cl ·s-~ 2 o:...f .L_ LtnJc2, Br:tAOik q~ O'-/ \& frwR.R.; 1 s;.1A~NA I S9 (-< 0.. C; llJ O i.:J '<0 \ ---l &-S-3 '2_ 0~ MAR 'fi.t-J'"r? Cfird '.SO AO i C\ \3 DP ¼' <ti:. E o )--r-i-\ 6" I\\ 31\\1.\SS TOW r\l t6 d-0'"3 '"LOtR ·'i=oP D \""CO SuO_, $? W •f\ L. 'l"B:r-c. M hb~ So¼6oN~w; • g "@S-2 "d.O'-f C-A-v'Y\ {:) (..:; B L. l _ f.bQ.f\ e L-A. croos7 9 t=\N~N'\Qi, . G.l-.0'~ \ ,r.,_ ~ u Pi C. E. Box \'"L . c...AI'<. t"l\ C! r-. q'2.0i17 t'/J ""2. $"'2 '"L___eJY1 )0 \/ \e. .. t-oR. r-~ AIA. \<:. ~ ''2> \ \-\ ~ W\ L...t) c.Jc.. (o ""d---6"°7... O_CJL( C-A-A. L~ (3(1 C) ~, - ('() ~Q. ~ 'w\ AX '1 l\l ,,_..-. ~ 7 U Gil-< ftl. l) ft W ~u ,../f-S 11€~ g,<9~ \) t'\ N ('.) t-r~ l-, n A.\ °'=-Q, BAe IA q D ~tL . -3-· • APPi::iCAf~·oN FOR CHANGE OF ZorF··< OWNER AND/OR OWNER 1 S AUTHORIZED AGENT AFFIDAVIT STATE OF CALIFORNIA) COUNTY OF SAN DIEGO) SS CITY OF CARLSBAD ) TI-J.E C..~ ;QT811\J s A NC.~oR 8-e::,~ 1) n] e___ I, (We) E'. 'R1e.\-tB:G,O P1::t-"1:F-'"I being duly sworn depose and (Name) ' declare to the best of au R knowledge that the foregoing is __,(~m-y =--, ---o---urf"""T"-"---- t rue and correct under the penalty of purjury: I • EXECUTED AT C..J~ (J_l~ BAD (City) DATE ·l (Month) c_~r (State 7S (Year) APPLICANT, OWNER AND/OR OWNER'S AUTHORIZED AGENT: I T-H6 CA 0° 8 \ l'V S A-t~H-a,R ~ ~ \·!~ E 1::<~ e.:dAP-{.J ~t , c ~er (Print Name) (Signature) -- SU~SCRIB'ED AND SWORN TO BEFORE ME THIS ________ ·DAY OF _______ _ (Notary Public) -4- ! !- I) • ·APPLi"cATroN FOR CHANGE OF zow· OWNER AND/OR OWNER'S AUTHORIZED AGENT AFFIDAVIT STATE OF CALIFORNIA) COUNTY OF SAN DIEGO) SS CITY OF CARLSBAD ) -~-E.._ ect'\)iCl'-V\..~ A\f'..c\.r,ov'Q~~ lV\c. I, (We) ~. K,c_\i,Ql('d P, tl: e._,f-being duly sworn depose and Name) declare to the best of ou.... r (my, our) knowledge that the foregoing is true and correct under the penalty of purjury: EXECUTED AT Ca..v--\s \oo__ct DATE \ (Month) (City) d-.d---. (Day) 7½ (Year) APPLICANT, OWNER AND/OR OWNER'S AUTHORIZED AGENT: ~ ~ ea. ~'t-o-l \/\.' o ~C,v-0\/""'C\_~ ~. \ \r\_c___ ~ . ~ \ c._ ~Q lfGt ~+ Print Name {Mailing Address) (Area Code) {Telephone Number) SIJ$SC~00o~AND♦6W08N~fA:;srffl~t:ME THIS ~~ "'--J, DAY OF To~. : ·· . •• DIANE P. EDMUNDS : _ __,;;;...,,:.,o:;;~=.....---- + NOTARY PUBLIC -CALIFORNIA : ! . , PRINCIPAL OFFICE IN . ~ ♦ SAN DIEGO COUNTY : ! My Commission Expires Sept. 26, 1978 ♦ rJWA-!vLl_) if ~ (Notary Public) -4- -APPLICATION FOR CHANGE OF ZONE "EXHIBIT 11 A11 FILING FEES: $100.00 plus $5.00 for each addi.tional lot or parcel. THIS APPLICATION SHALL Bt FORMALLY FILED ON THE FIRST MONDAY OF THE MONTH. THE PUBLIC HEARING AT THE PLANNING COMMISSION LEVEL WILL BE HELD NOT SOONER THAN THE SECOND TUESDAY OF THE FOLLOWING MONTH. IN ADDITION TO HAVING THIS APPLICATION COMPLETELY FILLED OUT, THE FOLLOWING ITEMS MUST BE ATTACHED: l. PLOT PLAN - A complete Plot Plan (see exhibit 11 B11 ) (28 copies & l sepia) 2. 300 FOOT RADIUS MAP - A map to scale not less than 111 = 200 1 showing each lot within 300 feet of the exterior boundaries of the subject property, the zone classification of each within 300 feet of the exterior boundaries of the subject property, and each lot within 300 feet of the exterior boundaries of the subject property shall be consecutively numbered to correspond with the property owner's list. 3. PROPERTY OWNERS' LIST - A typewritten list showing the number of each lot from Item 2 above, followed by the owner's name and address. In addition the applicant must file an affidavit that it is an accurate list taken from the latest equalized assessmwnt roll on file in the office of the Assessor of San Diego County, 855 Williamston Street, Vista, Californ'ia. (Phone (714) 724-8571. * * * - * * * * * * * * * * * * * * * * * * * * OFFICE· USE ONLY DATE RECEIVED: FORMAL FILING DATE: ---------------- RECEIPT NO. APPROVED FOR FILING WITH THE PLANNING COMMISSION BY=---~--~-~--(Plan~ing Department) -5- • f I . ' 0 0 EXHIBIT "B" ITEMS TO BE INCLUDED ON PLOT PLAN: . 1. NAME, ADDRESS AND PHONE NO. OF OWNER(S) OF SUBJECT PROPERTY. 2. NAME, ADDRESS AND PHONE NO. OF PERSON WHO PREPARED MAP. 3. NORTH POINT AND SCALE. 4. DATE OF PREPARATION. 5. VICINITY MAP. 6. NAME, LOCATION AND WIDTH OF ADJACENT STREETS. 7. BOUNDARIES OF PROPERTY AND APPROXIMATE DIMENSIONS. 8. APPROXIMATE CONTOURS AT NO GREATER THAN FIVE FOOT INTERVALS. 9. APPROXIMATE LOCATION OF EXISTING IMPROVEMENTS (STRUCTURES, STREETS). 10. LEGAL DESCRIPTION OF THE EXTERIOR BOUNDARIES 11. EXISTING AND PROPOSED GENERAL PLAN LAND-USE CLASSIFICATION. 12. EXISTING AND PROPOSED ZONING CLASSIFICATION. 13. EXISTING AND PROPOSED USE(S) OF THE PROPERTY. 14. ANY OTHER INFORMATION DEEMED NECESSARY BY THE PLANNING DEPARTMENT.· SUCH J\S: (a) (b) (c) Rationale for amendment. • Whv existina General Plan is not valid. -~ .. , The chanqe requ~sted is more appropriate for what reasons? -~ -------~-------------- -------------.--~ -----------------. --------..,.~t ,> .,. ,(.; V ~ , () 0 ze..-/s-/'- ENVIROW1ENTI\!. r:•iPJ\CT ASSESSnENT FORM ,-~61P1# EIA No . .203_D Date: /-g_o -. 7.5". Name.of 1\pplicant: FRANK. A 21 ·fY\ABuRy NOVAK.. Address: 3& 78 C..A~L.S 8 B D BLVD/ CA-RLS (3BD. CA • . .·. I Permit App1 ied For: :Zoi\J E C.H Arv Q,E C.-1 "To C.---1 Case Nos.:. --------,------'----~------ Location of Proposed Activity: '38 7& C...A-A.L~'B A:D· BtuD Cf➔O.LSJ3AD . CAL\ r= I I. Backgroun~. Infof~ation 1. Give a br.ief description of the proposed activity (attach any preliminary deve1opment plans). Ft,~ . SEA Foe>Q.· AND ,CS TE.AK How~-~ ••• -R't=L~ITAu AA)d r-w l ';H~f.l-Of\) s·FJLf; 1-.J a J ... J c_ .«) ·I i . - 2. Describe the activity .a-rea, including ·distinguishing natur~l and · manmade characteristics; a1so provide precise slope analysis when appropriate. . -r!-1 T?' p RO p E ·RT y l S PRE S E,r0'r i-<;1 . A HAW) t3 lJ AGE R ·1« B..S:T A·U Ro·~-\ ftN D D) rr SE ~-u E.. ON' -S(~L. E E:> Cs R.' ·f-i 'Few' ·ye A°r-<-. ~ Ft~o. ~H e. LA-rv a • (~ L. RE A Dy H A-'3:. 8 u '\ L (J I ru G RN 6 \ S .\3Lfic__k \D p ~-A--R.·k,~ G 11. • • 0 0 ENVIROi{:-:ENTAL IMPACT ASSESSMENT FORM II. Environmental I::mac.t ,1\nalysis Ans\'1er the following questions by placing a check in-the appropriate space. 1. Could the project significantly ch~hge present land uses in the vicfoity of the activity? 2. Could the activity affect the use of a recreational· area, or area of important aesthetic value? 3. Could. the activity ·affect the functioning of an established community or neighborhood? 4. Could the activity result in the displacement ·of community residents? 5. Are any of the natural or man-made features in the ac'tivity area unique, that ~s, not·found in other parts of the County, State, or nation? 6. Could the activity significantly affect a historical or archaelogical site or its setting? 7• Could t~e activity significantly affect th~ potential use, extraction, or conservation of a scar~e natural res- ource? 8. Does th~ activity area serve as a habitat, food source nesting pla~e, source of water; et~ .. for rare or endan~ered wildlife or fish. species?. 9. '·could the activity significantly affect fish, wildlife or plant life? • • 10. Are there any fare or ·endangered ~lant species· in the activity ·a·rea? • .. 11. Could the act'ivity change existing features of any. ·of the city's lago·ons, bays, or tidelands? 12. Could the activity change existing features of anY of • the Citf s _beaches? . 13. Could the activity result in the erosion or elimination of agricultural lands? • I • • ' 14. Could the activity serve to encourage dev~lopment of presently undeveloped areas or intensify ~evelopment of already developed areas? Yes No X t. :< X X A X x ' 0 15. i-Ji 11 the activ"ity_ require a variJnce froin estab1 ished environmental standards (air, \•tat.er, noise, etc)? 16. Will the activtty require certificatioh, authorization or issuance of a permit by any local, State or Federal environmental control agency? -r;+'Ez c.o r:;.·s, f-) l_ C.o ~~~;.\~':!:.lo ru • 17. Will the activity require issuance of a-variance or conditional use·· permit by the City? . 18. Will the activity involve the application, use, or disposal of potenti.ally fi2.zardous materials? 19. Will the activity involve construction of facifities in a flocd plain? 20. Will the activity involve construction of facilities on a slope of Yes 25 percent or greater? • • • • • • 21. Will the activity involve construction of facilities in the area of·an active fault? • 22. Could the activity result in the generation of significant amounts of noise? 23. Could the activity result in the generation of significant amounts of dust? .. 24. Will the activity involve the burning of ~rush; trees, or other materials? 25. · Could the activity-result in a significant change in the quality of any portion of the region's air or water resources? {Should note surface, ground water, off-shore). 26. Will there be a significant change to existing land form? (a) indicate estimated grading to be done in cubic yards. 0 (b) percen~age of alteration to the present land. form. <:) (c) maximum height of cut or fill slopes. • (9 27. Will the activity result. in substantial increases in the use of utilities, • sewers, drains or streets? • ~II. State of No Significant Environmental Effects If you have answered yes to one or more of the questions in Section II but· you think the activity will have no signific~nt environmental effects, indicate your reasons below: No x X •. ----------~--- 0 0 IV. Crnrrn2nts or Elc:borntions to P..nv of· the Questions in Section II. (If additional space is needed for answering any questions, attach additional sheets as may be needed.) Signature Q._ R,~ P H,J} • • ----=---'----"'_...:c.==. '--=_ ,._,_,_( P_e_r._s_o_n~_c_o_m_p""-et-,-. n-g-r-ep_o_r_t~)----- Da te Signed: __ /_-___,;Q::;.:.....:;:0~---7~5=-· __________ _ Conclusions (To be completed by the Planning Director). Place a check in the appropriate box. ( ) ( ) Further information is required. It has been determined that the project will not have significant environmental effects. ( ) You must submit a preliminary environmental impact statement by the follovling date--____,~---( } You • should make an appointment with the Planning Director to discuss further processing of your project, in accordance with Chapter 19.04 of the Municipal Code. DATE RECE.IVED: ------- BY: -.-------------. Planning Director, or, .i ... . : Revised 7 /3/7 4 0 0 ,_c I Tr). 10 F CARLSBAr") ENVrRONMENTAL PROTECTIOt~ ORDINANCE OF 1972 DECLARATION OF NEGATIVE (NON-SIGNIFICANT) ENVIRONMENTAL EFFECT APPLICANT C.A.P7~A-/A.J 5 4A)<2-/-l/)£/1GE .:Z-/lJG - ·337& ~LS;B;;J-{J. />Li/£)~ TYPE OF AP-PL I CATI ON: /'2.LJA}E,; &/fA-zJcfiE PERMIT AND/OR FILE t-10. _z=-e"'-,,,·---_/_S_/ ___________ _ THE ENVIRONMENTAL IMPACT ASSESSMENT HAS BEEN RECEIVED FOR: PROJECT DESCRIPTION i!ffi@(l'(r:JL,a,,'--7¥-, o/~ ·~ . . C!✓,..,I I& {l -o2. (/ U • PROJECT LOCATION 3878 &~ ~- I.declare that I have examined the information for the above project as submitted by the applicarit, and on the basis of the Environmental Impact Assessment questionnaire on file in my office as a public ·document, it is my determination that this project will not have any significant impact upon the environ- ment within the meaning of the California Environmental Quality. Act of 1970 and the Environmental Protection Ordinance of 1972 for the fol lowing reasons~~~ a.kU,~-<U--<~ • ~ ~ ~ ~ ;..&!, ~ . • . • . . -. --. rr • • • ·<J • • • • • • • . The Environmental Impact Assessment will be available for public reyiew and comment for FIVE. DAYS from date. Q DATED:._ (-c:<S~ 7_5 I • ·Rev. 2:/ 20 /7 4 E. I. S. Log No. _/ .. . . Jt-1 iv lft;r(/~/;.l/1,'\ F.P. No.--~-- F.P. Date ____ _ CII No _____ _ PERSONAL AFFIDAVIT IN SUPPORT OF APPLICATION ! . 1. Fu II Na me ____ '--1'--"_ .......... --"-"-........,;"'.z._,' t_....:::c=-..::h .... 1 _"l..::;..o::.1/'--L.....P~,.__---=-'/M::.....· :.....__.c.....,,..:........::-=--=,.=::::;,. Type License ,__,t/~7~--- (Applicant or Individual~ F,irst, Middle, Last) . 3. Premises Address · 6. Age: 7) .,. Sex: Hair: Eyes: 7. Marks and Scars 8. Driver's License No. Y. 3 i2=-2 VS?: , Social Security No. ~ Y~ ,_Cy .... 'i?-yo.(/ 9---1' lace of Birth. Over ,___ 7 ,<? -~ f' o /, (. ,/,, . I'< . Date 61Bi}'h <is -9 -J{,./&f 1£' ,rN f (Jf 11~.: -r.· ) k Clf,;f~,d '<' /ti(r;o-,,.. f,;<' 9-e Jc"} ,. ts Ul,,-';> l, ,_._ ·-9 4or;.'f...e ,.:"$ ..z;:5 ' ~a.-. a. >' \]O. )41) Do you now.have any.direct, or indire_ct, interest in any oJher ~-g!,9lic_9everage ~? ,,I}. j a<> _ ·_·-' Yes')( No ___ .lf"Yes,"explainfully: ,,,_ o..t2e,;..L-cr/1-4.. / ...... n~t .,,. (b) Have you ever been an alcoholic beverage lice'}S:ee or an ofJ.k. b or d i_zc.tor of -.,porporate licen~ee~ ;: -• 0 iritJ,,t)l Yes or No .V-e_~ If "Yes," explain fully /~ ..{)_s o ¥-s_Clt4 1 q"'--> ~ /1(/1 cl-, Clvc~ "2. J..:IV . --. ' / • / / • ~ '{ ~,;.. I Vo ~~-12 Cf ti, • ~ fb-.J • -1-';;, V""-.5'l,c fit ._e,. IJ-C' > .Qs;;-5 .h1fC. • • , · · · • {;;.q/,r 11. Have you, as an individual, a partner, or while an officer, director or stockholder of a corporate applicant or • licensee, ever had a liquor license denied, suspended, revoked or an Offer in Compromi_se accepted or rejected? ;4/o If "Yes," describe below: • (,,.;;;.~i-RHENT AN[)'PAST EMPLOYMENT ~ From To Mo/Yr • Mo/Yr Type of Work (for at least past five yea_rs): (Use additional sheet if. necessary) Firm Name City --------------------------------------------c---W,(/ftl eJ 3 W·11 Mei.vew 1u..4<Cc-s~' • 7 /!lo ./1--J-?"Jr J!,.a«e:~ 1 . 1 your spouse ___,_,._,_-=.,~7,,..__.l'.'--'::C.___.c..cy;,:;..:. _ _;;__,.-=_......:;..7 work on prem I ses. t _ (Name) (Yes or'No) • (Date and place married). 14. Have you ever, anywhere or at any time, ( 1) forfeited bail, (2) been arrested, (3) convicted, (4)-fined, (5) jailed, or (6) placed on probation for any violation of law?(lf any of these events has occurred, this question _ must be answered "Yes" regardless of subsequent court action resulting in dismissal or expungement, unless··an order sealing records under Section• '1203.45 of the Penal Code, relating· to persons under age 21 years, has·· • been issued. If no order has been issued, the answer must be "Yes.") Explain each event fully: Date of Arrest Place Arrested ABC-208 (9/73) Offense Results I have read all of the above and declare under penalty of perjury that each and every statement made is true, correct and complete.