HomeMy WebLinkAboutADJ 02-13; KELLETT ADJUSTMENT PLAT; Engineering ApplicationrAPPLI
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CAflON
ENGINEERING PLAN CHECK - .
; : Complete iñf6FthatiónWrite N/AwhennOt all appropriate apliblé;.f
PROJECT NAME: '//e7t , fj•• . DATE:.
PROJECT DESCRIPTION:. S
All
PROJECT ADDRESS:
LOTNO(S).: ' MAP. NO.: ,,4.,'1 APN(S).: 7 3,Z
NUMBER OF LOTS: NUMBER OF ACRES:
OWNER: (j.j1.-/ F /euJd± APPLICANT: ?
Mailing Address: 4/14/ Pay-IC 1w Mailing Address:
72003 C/ba d C4' 92-o/ - i
Phone Number: =-?(,0 722 - 012-c Phone Number: 4'3 - s'
Fax Number: 54n1e, a6 qJx/e_.CAL. !- Fax Number: .
E-Mail: .
-
E-Mail:
I certify that I am the' legal owner and that all theabove -
information is true an correct to the best of my kfi6vledge.
Signature: j D Signature: Date: '1 ?t.'Z
SOILS ENGINEER:
FIRM: /5://, FIRM: .
Mailing Address: 4!-31 Mailing Address:
4
-Phone Number: 7(0 4- Phone Number:
Fax Number: Fax Number: ..
-
E-Mail: E-Mail:
State Registration Number: M- 3'?.' State Registration Number:
ADDITIONAL COMMENTS:
IMPROVEMENT VALUATION
What water district is the proposed project located in? (check one) -
ICarlsbad Municipal Water District DOlivenhain . UValtecitos
If in the Carlsbad Municipal Water District, what is the total cost estithate, including the 15%
contingericy fee; for water and reclaimed water improvements, sewer. (for Carlsbad Municipal
Water District only), street, public (median) landscape and irrigation, and drainage improvements
(if applicable)?-.' . . S $
- . . GRADING QUANTITIES
cut cy fill cy •. remedial cy import cy export cy
a-.
SEE REVERSE SIDE -
H:IDEVElOPMENT SERVlCESIMASTERSIAoolicatlon for Enaineeiina Plan Check . - . Revised 1/14/02
CITY OF CARLSBAD- ENGINEERING DEPA ENT
I APPLICATION
ENGINEERINGLAN CHECK
Complete all appropriate information Write N/A when not applicble
-
. 'FOR CITY USE ONLY
APPLICATION FOR PROECr DAWING DEPOSIT/FEES
(' all that apply) ui.. NUMBER -• '.'•
O Adjustment Plat (AD))
O Certificate of Compliance (CE)
LI Dedication of Easement (PR)
Type:_________________
Type:__________________
Type:__________________
E] Encorachment Permit (PR)
LI Final Map (FM)
Grading Plancheck (DWG)
O Improvement Plancheck (DWG)
O Parcel Map (PM)
Quitclaim of Easement (PR)
Type:_________________
Type:_________________
Type:_________________
fl Reversion to Acreage (RA)
Street Vacation (STV)
O Tentative Parcel Map (MS)
O Certificate of Correction
(CCOR)
U Covenant of Easement (PR)
Substantial Conformance
Exhibit (SCE)
O Other
APPLICATION ACCEPTED BY
HJDEVELOPMENT SERVICES/MASTERS/Application for Engineering Plan Check Page 2 Revised 1/14102
. S
PROJECT MAP REVIEW COMPLETION
The following project maps have been reviewed and are recommended for approval:
Project Name:
Project No.:
Map No.:______
ofl
Sheets No.:
through
DECLARATION OF RESPONSIBLE CHARGE
I hereby declare that I have exercised responsible charge over the map review of
this project as defined in Section 8703 of the Business and Professions Code to
determine that the maps are found to be in substantial compliance with applicable
codes and standards.
Map review of these project maps does not relieve the Land Surveyor or Engineer of
Work of the responsibilities of compliance with state and local ordinances.
Berryman & Henigar
11 590 West Bernardo Court
San Diego, CA 92127
(619)451-6100
Signed) UND e____________________
Michael L. Prrn I tffjL%E. 8
Expir ?6 Da6Zé'613O104 4
No.: 5778
e Op CA1\"1