HomeMy WebLinkAboutMCUP 07-02x1; North Batiquitos WCF; Conditional Use Permit (CUP) (2):\~
~ CITY OF
CARLSBAD
APPLICATIONS APPLIED FOR: (CHECK BOXES)
LAND USE REVIEW
APPLICATION
P-1
Development Services
Planning Division
1635 Faraday Avenue
(760} 602-4610
www.carlsbadca.gov
Development Permits (FOR DEPT. USE ONLY) Legislative Permits (FOR DEPT. USE ONLY)
0 Administrative Permit
0 Coastal Development Permit (*} 0 Minor
fRJ Conditional Use Permit (*)
1!1 Minor 0 Extension
0 Environmental Impact Assessment
0 Habitat Management Permit
0 Hillside Development Permit (*)
0 Planned Development PermH
0Minor
0 Residential 0 Non-Residential
0 Planned Industrial Permit
0 Planning Commission Determination
D Site Development Plan
0 Special Use Permit
0 Tentative Tract Map
0 Variance 0 Administrative
0 General Plan Amendment
0 Local Coastal Program Amendment (*)
0 Master Plan MCUP 07-02 )( f 0Amendment
0 Specific Plan 0 Amendment
0 Zone Change (*)
0 Zone Code Amendment
List other application• not specified
D
D
D
(*) = eligible for 25% discount
1-------1
NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPUCATIONS MUST BE SUBMITTED PRIOR TO 3:30P.M. A PROPOSED PROJECT REQUIRING ONLY ONE
APPUCATION MUST BE SUBMITTED PRIOR TO 4:00P.M.
ASSESSOR PARCEL NO(S).: :t14=4!@) 18 66 d 14 -L\ 5 Q-31
PROJECT NAME: NORTH BATIQUITOS WCF
BRIEF DESCRIPTION OF PROJECT:
Extension of the existing MCUP 07-02 approved May 8, 2007 located at 760 Macadamia Drive
BRIEF LEGAL DESCRIPTION: Lot 9 and 10 of Carlsbad Tract No. 18-5, In the City of Carlsbad, County of San Diego, State of
California, according to map thereof No. 10899 Filed in the Office of the County Recorder of San Diego County April 11, 1984
LOCATION OF PROJECT: 760 Macadamia Drive, Carlsbad CA
ON THE:
BElWEEN
P-1
WEST
(NORTH, SOUTH, EAST, WEST)
San Diego Freeway (1-5)
(NAME OF STREET)
SIDE OF
AND
STREET ADDRESS
AVENIDAS ENCINITAS
(NAME OF STREET)
Avenidas Encinitas
(NAME OF STREET)
Page 1 of5 ·D~wD\ 01 ~ised07/10
c
OWNER NAME (Print): Pinnacle Carlsbad, LLC
MAILING ADDRESS: 8369 Vickers Street, Suite 101
CITY, STATE, ZIP: San Diego, CA 92111
TELEPHONE: 858-974-8201
EMAIL ADDRESS:
I CERTIFY THAT I AM THE LEGAL OINNER AND THAT All THE ABOVE
INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE. ~ ~ 1 l~}IL
SIGNATURE .. ~ DA E
0
APPLICANT NAME (Print): Nextel of California, Inc
MAILING ADDRESS: 6391 Sprint Parkway
CITY, STATE, ZIP: Overland Park, KS 66251
TELEPHONE: 800-357-7641 ----------------------------EMAIL ADDRESS: landlordsolutlons@sprint.com
APPLICANT'S REPRESENTATIVE (Print): Heidi Thome ~~~~~--------------------------------------------MAILING ADDRESS: 3401 International Airport Drive, Suite 500
CITY, STATE, ZIP: Charlotte, NC 28208
TELEPHONE: 704-921-7443 -----------------------------------------------------------------EMAIL ADDRESS: Heidi. Thome@ericsson.com
HAT I AM THE LEGAL REPRESENTATIVE OF THE
D THAT All THE ABOVE INFORMATION IS TRUE AND
BEST OF MY KNOWLEDGE.
IN THE OCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNING
COMMISSIONERS OR CITY COUNCIL MEMBERS TO INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS
APPLICATION. IIWE CONSENT TO ENTRY FOR THIS PURPOSE.
NOnCE OF RESTRICnON: PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF RESTRICTION BEING
RECORDED ON THE TITLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT. NOTICE OF RESTRICTIONS RUN WITH
THE LAND AND BIND AN~S IN INTEREST.
PROPERTY OWM;R"SIGNATURE
FOR CITY USE ONLY
P-1 Page 2of5
CITY OF CARLSBAD
PLANNING DIVISION
DATE STAMP APPLICATION RECEIVED
RECEIVED BY:
Revised 07/10
City df Carlsbad
Faraday Center
Faraday Cashiering 001
1203901-1 02/08/2012 32
Wed, Feb 08, 2012 08:28 AM
Receipt Ref Nbr: R1203901-1/0006
PERMITS -PERMITS
Tran Ref Nbr: 120390101 0006 0006
Trans/Rcpt#: R0088287
SET #: MCUP0702X1
Amount:
Item Subtota 1:
Item Tot a 1:
ITEM(S) TOTAL:
Check (Chk# 12136029)
Check (Chk# 12151852)
Total Received:
Have a nice day!
1 @ $333.04
$333.04
$333.04
$333.04
$315.00
$18.04
$333.04
**************CUSTOMER COPY*************
City of Carlsbad
1635 Faraday Avenue Carlsbad CA 92008
11111111111111111111111111111~ 1111111111111111111111~ 11111111
Applicant: NEXTEL OF CALIFORNIA
Description Amount
MCUP0702X1 333.04
7 6 0 MACADAMIA DR CBAD
Receipt Number: R0088287 Transaction ID: R0088287
Transaction Date: 02/08/2012
Pay Type Method Description Amount
Payment Check 333.04
Transaction Amount: 333.04
0 0
>4'~ ,,.
~ CITY OF
DISCLOSURE
STATEMENT
P-1(A)
Development Services
Planning Department
1635 Faraday Avenue
(760} 602-4610
www.carfsbadca.gov CARLSBAD
Applicant's statement or disclosure of certain ownership interests on all applications which will
require discretionary action on the part of the City Council or any appointed Board, Commission
or Committee.
The following information MUST be disclosed at the time of application submittal. Your project
cannot be reviewed until this information is completed. Please print.
Note:
Person is defined as "Any individual, firm, co-partnership, joint venture, association, social club, fraternal
organization, corporation, estate, trust, receiver, syndicate, in this and any other county, city and county,
city municipality, district or other political subdivision or any other group or combination acting as a unit."
Agents may sign this document: however, the legal name and entity of the applicant and property owner
must be provided below.
1. APPLICANT (Not the applicanfs agent)
Provide the COMPLETE. LEGAL names and addresses of ALL persons having a
financial interest in the application. If the applicant includes a corporation or partnersbip,
include the names, titles, addresses of all individuals owning more than 10% of the
shares. IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE
INDICATE NON-APPLICABLE (N/A) IN THE SPACE BELOW. If a oubljcly-owned
corooration, include the names, titles, and addresses of the corporate officers. (A
separate page may be attached if necessary.)
Person Heidi Thome Corp/Part Nextel of California, Inc.
Title Authorized Representative Title ____________ _
Address:...._ ________ _ Address 6391 Sprint Parkway, Overland Park KS 66251
2. OWNER (Not the owner's agent)
P-1(A)
Provide the COMPLETE. LEGAL names and addresses of ALL persons having any
ownership interest in the property involved. Also, provide the nature of the legal
ownership (i.e., partnership, tenants in common, non-profit, corporation, etc.). If the
ownership includes a corporation or parmershjp, include the names, titles, addresses of
all individuals owning more than 10% of the shares. IF NO INDIVIDUALS OWN MORE
THAN 10% OF THE SHARES, PLEASE INDICATE NON-APPLICABLE (N/A) IN THE
SPACE BELOW. If a publicly-owned corooration, include the names, titles, and
addresses of the corporate officers. (A separate page may be attached if necess .)
Person _________ _
Title. __________ _
Address. ________ _
Corp/Part Pinnacle Carlsbad, LLC
Title !VI o......~ f'4..R.-..4--J
Address 8369 Vickers Street, Suite 101
San Diego, CA 92111
Page 1 of2 Revised 04109
0 0
3. NON-PROFIT ORGANIZATION OR TRUST
If any person identified pursuant to (1) or (2) above is a nonorofit organization or a trust,
list the names and addresses of A!f! person serving as an officer or director of the non-
profit organization or as trustee or beneficiary of the.
Non Profit/Trust Non Profitrrrust. ________ _
Title Title. ____________ _
Address. _________ _ Address. _____________ __
4. Have you had more than $500 worth of business transacted with any member of City
staff, Boards, Commissions, Committees and/or Council within the past twelve (12)
months?
D Yes ~No If yes, please indicate person(s):, ___________ _
NOTE: Attach additional sheets if necessary.
Heidi J Thome
Print or type name of owner Print or type name of applicant
Signature of owner/applicant's agent if applicable/date
Print or type name of owner/applicant's agent
P-1(A) Page2of2 Revised 04109
/~l~ "'~· ~ CITY OF
CARLSBAD
0
HAZARDOUS WASTE
AND SUBSTANCES
STATEMENT
P-1(C)
0
Development Services
Planning Department
1635 Faraday Avenue
(760) 602-4610
www .carlsbadca.gov
Consultation of Lists of Sites Related to Hazardous Wastes
(Certification of Compliance with Government Code Section 65962.5)
Pursuant to State of California Government Code Section 65962.5, I have consulted the
Hazardous Waste and Substances Sites List compiled by the California Environmental
Protection Agency and hereby certify that (check one):
00 The development project and any alternatives proposed in this application are not contained on the
lists compiled pursuant to Section 65962.5 of the State Government Code.
0 The development project and any alternatives proposed in this application !!!. contained on the lists
compiled pursuant to Section 65962.5 of the State Government Code.
APPLICANT
Name: Nextel of California. Inc.
Address: 6391 Sprint Parkway, MS: KSOPHT0101-Z2650
Overland Park, KS 66251-2650
PROPERTY OWNER
Name: Pinnacle Carlsbad, LLC
Address: 8369 Vickers Street, Suite 101
San Diego, CA 92110-2113
Phone Number: 800-357-7641 Phone Number: 858-974-8201 ------------------------
Address of Site: 720 Macadamia Drive, Carlsbad CA 92008
Local Agency (City and County): Carlsbad, San Diego County
Assessor's book, page, and parcel number:. __ 2_14_-4_5_0-_1_8_-o_o ______________ _
Specify list(s): State of California Hazardous Waste and Substances Site List
Regulatory Identification Number.:_-----------------------
fAL~roperty Owner Signature/Date
The Hazardous Waste and Substances Sites List (Cortese List) is used by the State, local
agencies and developers to comply with the California Environmental Quality Act requirements
in providing information about the location of hazardous materials release sites.
P-1(C) Page 1 of2 Revised 04109
·<~ '\~ W CITY OF
CARLSBAD
STORM WATER
STANDARDS
QUESTIONNAIRE
E-34
Development Services
Engineering Department
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
sEcnoN1
NEW DEVELOPMENT
PRIORITY PROJECT TYPE YES NO Does you project meet one or more of the following criteria:
1. Home subdMsion of 100 units or more. X Includes SFD MFD, Condominium and Apartments
2. Residential develooment of 10 units or more.
Includes SFD, MFD,Condominlum and Apartments X
3. Commercial and Industrial develor~.ment greaf!l.r than 100,000 sguare feet inclu.ding r~.arl<ing areas.
Any development on private land that is not for heavy lndustJial or residential uses. Example: Hospitals, X Hotels Recreational Facilities, Shopping Malls etc.
4. Heavv Industrial I lndustrv greater than 1 acre (NEED SIC CODES FOR PERMIT BUSINESS TYPES)
SIC codes 5013,5014,5541,7532-7534, and 7536-7539 X
5. Automotive f9D8/r shop. X SIC codes 5013,5014,5541,7532-7534, and 7536-7539
6. A Nert. Ru.tf!um.nt g!§ th§.ll,nd area of r;mvelooment i§. 5,Q!}Q saua!§ ~tor mol8 includi!lfl. ~rl<ing areas. X
SIC code 5812
7. Hillside develooment
(1) greater than 5,000 square feet of impervious surface area and (2) development will grade on any natural X
slope that is 25% or greater
8. Environmentally Sensitive Ante (ESAl.
Impervious surface of 2,500 square feet or more located within, "directly adjacent"2 to (within 200 feet), or X
"discharging directly to"3 receMng water within the ESA 1
9. Parkinalot X Area of 5,000 square feet or more, or with 15 or more parking spaces, and potentially exposed to urban runoff
10. Retail Ggol/ne OUtl§.t§.-servlr!Jl. more than 100 vehicles r~.er day. X Serving more than 100 vehicles per day and greater than 5,000 square feet
11. Streets. roads. hiahways, and hewavs. X Project would create a new paved surface that is 5,000 square feet or greater.
12. Coastl,l DeveloPment Zone.
Within 200 feet of the Pacific Ocean and (1) creates more than 2500 square feet of impenneable surface or (2) X
increases lmpenneable surface on property by more than 1 0%.
1 ESA (Environmentally Sensitive Areas) include but are not limited to all Clean Water Act Section 303(d) impaired water bodies;
areas designated as Areas of Special Biological Significance by the State Water Resources Control Board (Water Quality Control
Plan for the San Diego Basin (1994) and amendments); water bodies designated with the RARE beneficial use by the State Water
Resources Control Board (Water Quality Control Plan for the San Diego Basin (1994) and amendments); areas designated as
preserves or their equivalent under the Multi Species Conservation Program within the Cities and County of San Diego; and any
other equivalent environmentally sensitive areas which have been identified by the co-pennlttees.
2 "Directly adjacent" means situated within 200 feet of the environmentally sensitive area.
3 "Discharging directly to• means outflow from a drainage conveyance system that is composed entirely of flows from the subject
development or redevelopment site, and not commingled with flow from adjacent lands.
Section 1 Rgultl:
If you answered YES to AHY of the questions above you have a PRIORITY project and PRIORITY project requirements DO apply.
A Storm Water Management Plan, prepared in accordance with City Stonn Water Standards, must be submitted at time of
application. Please check the "MEETS PRIORITY REQUIREMENTS" box in Section 3.
If you answered NO to ALL of the questions above, then you are a NON.PRIORITY project and STANDARD requirements apply.
Please check the "DOES NOT MEET PRIORITY REQUIREMENTS" box in Section 3.
E-34 Page2of3 REV 8112109
.. <~'~·-..
"' "4. , ~ CITY OF
CARLSBAD
STORM WATER
STANDARDS
QUESTIONNAIRE
E-34
Development Services
Engineering Department
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
I SEcnoNz
SIGNIFICANT REDEVELOPMENT: YES NO
1. If the existing development was constrUcted today, would it qualify as a priority project? (Priority projects are X defined in Section 1)
If you answered YES, please proceed to question 2.
If you answered NO, then you ARE NOT a significant redevelopment and you ARE NOT subject to PRIORrTY project requirements,
only STANDARD requirements. Please check the "DOES NOT MEET PRIORITY REQUIREMENTS" box in Section 3 below.
2. Is the project solely limited to one of the following:
a. Trenching and resurfacing associated with utility wor1<?
b. Resurfacing and reconflguring existing surface parking lots?
c. New sidewalk construction, pedestrian ramps, or bike lane on public and/or private existing roads?
d. Replacement of existing damaged pavement?
If you answered NO to ALL of the questions, then proceed to Question 3.
If you answered YES to ONE OR MORE of the questions then you ARE NOT a significant redevelopment and you ARE NOT subject to
PRIORrTY project requirements, only STANDARD requirements. Please check the "DOES NOT MEET PRIORITY REQUIREMENTS"
box in Section 3 below.
3. Will the development create, replace, or add at least 5,000 square feet of impervious surfaces on an existing X development, or be located within 200 feet of the Pacific Ocean and (1) create more than 2500 square feet of
impenneable surface or_(2) increase imj)enneable surface on property by more than 10%?
If you answered YES, you ARE a significant redevelopment and you ARE subject to PRIORITY project requirements. Please check
the "MEETS WITH REQUIREMENTS" box in Section 3 below.
If you answered NO, you ARE NOT a significant redevelopment, and you ARE NOT subject to PRIORITY project requirements, only
STANDARD requirements. Please check the 'DOES NOT MEET PRIORITY REQUIREMENTS" box in Section 3 below.
I SECTION3
Qu!!tlonnalre R•ults:
0 MY PROJECT MEETS PRIORITY REQUIREMENTS. MUST COMPLY WITH PRIORITY PROJECT STANDARDS AND MUST
PREPARE A STORM WATER MANAGEMENT PLAN FOR SUBMITTAL AT TIME OF APPLICATION.
0 MY PROJECT DOES NOT MEET PRIORITY REQUIREMENTS AND MUST ONLY COMPLY WITH STANDARD STORM
WATER REQUIREMENTS.
licant Information and s· natul8 Box
Address: Assessor's Parcel Number(s): This Box for City Use On~
760 Macadamia Drive 214-450-18-00
Applicant Name: Applicant Title: City Concurrence: I Yes
I
Nextel of California, Inc. Authorized representative By:
Date: Date:
December 1, 2011 Project ID:
E-34 Page 3of3 REV 8112109
No
MCUP & CUP ANNUAL REVIEW SHEET r1! r: ~nf'/
INSTRUCTIONS
1. COMPLETE PROJECT INFORMATION BELOW AND PRINT COPY.
2. DOWNLOAD (DMS) RESOLUTIONS AND REVIEW ALL CONDITIONS AND
APPROVED PLANS (COORDINATE WITH OTHER DEPARTMENTS).
3. REVIEW CODE COMPLAINT HISTORY (CODE ENFORCEMENT, POLICE,
FIRE, ETc.).
4. CONTACT APPLICANT (OR OWNER) AND SCHEDULE AN APPOINTMENT
FOR THE REVIEW.
5. COMPLETE REVIEW INFORMATION SECTION DURING REVIEW.
6. HAVE SENIOR PLANNER REVIEW AND SIGN.
7. PLACE COMPLETED REVIEW SHEET IN ADMIN IN-BOX FOR PROJECT FILE
(ADMIN WILL FILE).
PROJECT INFORMATION
CASE NAME: North Batiquitos WCF
CASE NUMBER(S): "-"M=C=U=P_,0'-'-7__,-0=2x=1~---------------
APPROVING RESO NO(S). ""le"'tt""'er,__ _______________ _
PLANNER COMPLETING REVIEW: ""C"-'hr"'i"'"s "'"Se""x""to""n'-'---------------
PROJECT HISTORY
Does project have a code complaint history?
If yes, check those that apply and explain below.
0 Code Enforcement 0 Police
0 Yes
Comments (include corrective actions taken and date compliance obtained):
.
~No
0 Fire Prevention
Q:'-CED'-PLANNING'-ADMIN'-TEMPLATES'-MCUPANNUALREVIEWSHEET 03/13
REVIEW INFORMATION
Hasthe permit expired? DYes ~No Permit expires: 03 L 21 L 22
Date of review: 4Ll6Ll3
Name: Sj2rint Ericsson ~ Applicant D Owner D Other
If other, state title:
*CURRENT APPLICANT INFORMATION:
Name: Sj2rint Ericsson Phone: 858-650-4249
Contact name (if different): Ste12hen DeMars
Address: 5761 Coj2lex Dr, San Diego CA 92111
Mailing (if different):
E-mail: Ste12hen.demars@s12rint.com (optional)
*CURRENT OWNER INFORMATION:
Name: Pinnacle Carlsbad LP Phone: 858-974-8201
Contact name (if different):
Address: 8369 Vickers St #101, San Diego CA 92111
Mailing (if different):
E-mail: (optional)
Does project comply with conditions of resolution(s) and approved plans?
[;g] Yes D No If no, list below the condition(s) and/ or plan aspects the project is
not in compliance with per resolution number or exhibit.
Corrective action( s) to be taken:
Date planner completed follow-up review and confirmed project compliance:
Planner Signature
~ 1.kla~4~'-
eniOTPialmer
*Applicant and owner information must be updated for annual review· to be complete.
Q:'\CED'\PLANNI NG'\AD Ml N'\ TEMPLA TES'\M CUPANNUALREVIEWSHEET 03/13
.,df~A_ C I T Y 0 F
VcARLSBAD
~5~~\1
LJ FILE
Planning Division www.carlsbadca.gov
March 22, 2012
Nextel of California, Inc.
6391 Sprint Pkwy
Overland Park, KS 66251
SUBJECT: MINOR CONDITIONAL USE PERMIT NO. MCUP 07-02x1 -NORTH BATIQUITOS WCF -
Request for approval of a Minor Conditional Use Permit Extension to allow the continued operation and
maintenance of an existing Wireless Communication Facility (WCF) for Sprint Nextel consisting of six roof
mounted PCS panel antennas, and one oval positioning antenna and six ground mounted radio equipment
cabinets located at 760 Macadamia Drive, in the General Commercial (C-2) Zone and Local Facilities
Management Zone 22.
Dear Heidi Thorne,
The City Planner has completed a review of your application for a Minor Conditional Use Permit Extension
MCUP 07-02x1 -NORTH BATIQUITOS WCF for the continued operation and maintenance of a Wireless
Communication Facility at 760 Macadamia Drive. A notice was sent to property owners within a 300' radius
of the subject property requesting comments regarding the above request. No comments were received
within the ten day notice period (ending on March 19, 2012). After careful consideration of the
circumstances surrounding this request, the City Planner has determined that the four findings required for
granting a Minor Conditional Use Permit Extension can be made and therefore, APPROVES this request
based on the following findings and conditions.
Findings:
1. All of the findings contained in the City Planner's decision letter, dated May 8, 2007, for MCUP 07-
02, apply to this extension and are incorporated herein by reference and remain in effect.
2. That such permits and approvals as extended are consistent with the requirements of Title 21 of this
code at the time of their extension.
3. That the City Planner has determined that the project belongs to a class of projects that the State
Secretary for Resources has found do not have a significant impact on the environment, and it is
therefore categorically exempt from the rlequirement for the preparation of environmental
documents pursuant to Section 15301 -(Existing Facilities), of the state CEQA Guidelines.
Additionally, as T-Mobile must comply with FCC regulations, radio frequency emissions from the
proposed facility are below levels established as acceptable by the FCC, and are therefore not
considered a health hazard. In making this determination, the City Planner has found that the
exceptions listed in Section 15300.2 of the state CEQA Guidelines do not apply to this project.
Conditions:
1. This Minor Conditional Use Permit Extension is granted for a period of ten (10) years from March
22, 2012 through March 21, 2022.
1635 Faraday Avenue, Carlsbad, CA 92008-7314 T 760-602-4600 F 760-602-8559 ®
MCUP 07-02x1-NORTH BATIQUITOS WCF
March 22, 2012
Page 2
2. All of the conditions contained in the City Planner's decision letter dated May 8, 2007, for MCUP
07-02 apply to this extension and are incorporated herein by reference and remain in effect except
for Planning Condition No. 10 which is superseded by Condition No. 1 ofthis approval letter.
Engineering:
3. Developer shall comply with the City's Stormwater Regulations, latest version, and shall implement
best management practices at all times. Best management practices include but are not limited to
pollution treatment practices or devices, general housekeeping practices, pollution prevention and
educational practices, maintenance procedures, and other management practices or devices to
prevent or reduce the discharge of pollutants to stormwater, receiving water or stormwater
conveyance system to the maximum extent practicable. Developer shall notify prospective owners
and tenants of the above requirements.
NOTICE
Please take NOTICE that approval of your project includes the "imposition" of fees, dedications, reservations,
or other exactions hereafter collectively referred to for convenience as "fees/exactions."
You have 90 days from the date of final approval to protest imposition of these fees/exactions. If you protest
them, you must follow the protest procedure set forth in Government Code Section 66020{a), and file the
protest and any other required information with the City Manager for processing in accordance with
Carlsbad Municipal Code Section 3.32.030. Failure to timely follow that procedure will bar any subsequent
legal action to attack, review, set aside, void, or annul their imposition.
You are hereby FURTHER NOTIFIED that your right to protest the specified fees/exactions DOES NOT APPLY
to water and sewer connection fees and capacity charges, nor planning, zoning, grading or other similar
application processing or service fees in connection with this project; NOR DOES IT APPLY to any
fees/exactions of which you have previously been given a NOTICE similar to this, or as to which the statute of
limitations has previously otherwise expired.
This decision may be appealed by you or any other member of the public to the Planning Commission within
ten days of the date of this letter. Appeals must be submitted in writing to the Planning Division at 1635
Faraday Avenue in Carlsbad, along with a payment of $620.00. The filing of such appeal within such time
limit shall stay the effective date of the order of the City Planner until such time as a final decision on the
appeal is reached. If you have any questions regarding this matter, please feel free to contact Chris Sexton at
{760) 602-4624.
Sincerely,
CHRIS OeCERBO
Principal Planner
CD:CS:bd
c: Don Neu, City Planner
Mike Peterson, Development Services Manager
Glen Van Peski, Senior Civil Engineer
Chris DeCerbo, Principal Planner
T¢a Levy, Project Engineer
vfileCopy
OMS/Data Entry
~ '~lq,l\v
~ .~ _4~.A._ CITY OF ~
VcARLSBAD
FILE COPY
Planning Division www.carlsbadca.gov
March 7, 2012
Heidi Thorne
Sprint
3401 International Airport Drive #500
Charlotte NC 28208
SUBJECT: MCUP 07-02X1 -NORTH BATIQUITOS WCF CALIFORNIA ENVIRONMENTAL QUALITY
ACT (CEQA) APPLICABILITY/PROCESS DETERMINATION
This is to advise you that after reviewing the application for the project referenced above, the City has
determined that the following environmental review process (pursuant to CEQA) will be required for the
project:
The project is exempt from the provisions of CEQA, pursuant to CEQA Guidelines Section 15301 -
Existing Facility. No environmental review is required for the project.
A Notice of Exemption will be filed after approval of the project with the San Diego County Clerk's Office
which involves a filing fee. Please submit a check to the project planner in the amount of $50.00 made
out to the San Diego County Clerk.
For additional information related to this CEQA applicability/process determination, please contact the
project planner, Chris Sexton, at {760) 602-4624 or chris.sexton@carlsbadca.gov.
DON NEU, AICP
City Planner
DN:CS:bd
c: Pinnacle Carlsbad, LLC, 8369 Vickers Street, #101, San Diego CA 92111
Nextel of California, 6391 Sprint Parkway, Overland Park, KS 66251
Mike Peterson, Development Services Manager
Christer Westman, Senior Planner
Tecla Levy, Project Engineer
Chris DeCerbo, Principal Planner
File Copy
Data Entry
1635 Faraday Avenue, Carlsbad, CA 92008-7314 T 760-602-4600 F 760-602-8559 ®
Planning Division
March 7, 2012
Heidi Thorne
Sprint/Ericsson
3401 International Airport Dr. #500
Charlotte NC 28208
SUBJECT: 1st REVIEW FOR MCUP 07-02x1-NORTH BATIQUITOS WCF
www.carlsbadca.gov
Thank you for applying for Land Use Permits in the City of Carlsbad. The Planning Division has reviewed
your Minor Conditional Use Permit, application no. MCUP 07-02xl, as to its completeness for
processing.
The application is complete, as submitted. Although the initial processing of your application may have
already begun, the technical acceptance date is acknowledged by the date of this communication. The
City may, in the course of processing the application, request that you clarify, amplify, correct, or
otherwise supplement the basic information required for the application. In addition, you should also
be aware that various design issues may exist. These issues must be addressed before this application
can be scheduled for a hearing. The Planning Division will begin processing your application as of the
date of this communication.
Sincerely,
CHRIS DeCERBO
Principal Planner
CD:CS:bd
c: Pinnacle Carlsbad LLC, 8369 Vickers St. #101, San Diego CA 92111
Nextel of California, 6391 Sprint Parkway, Overland Park, KS 66251
Don Neu, City Planner
Mike Peterson, Development Services Manager
Glen Van Peski, Senior Civil Engineer
Tecla Levy, Project Engineer
Chris DeCerbo, Principal Planner
File Copy
Data Entry
T 760-602-4600 F 760-602-8559
Sprint')
Together with NEXTEL
February 6, 2012
Sprint Nextel
6391 Sprint Parkway,
M/5 KSOPHT0101-Z2650
Overland Park, KS 66251
Office: (800) 357-7641 Fax: (913) 523-9735
VIA UPS NEXT DAY AIR SAVER
Tracking# 1Z 212 67A 13 9027 9564
Ms. Chris Sexton
City of Carlsbad
Planning Department
1635 Faraday Avenue
Carlsbad, CA 92008
RE: Nextel Communication Tower Site-Site 10 #: CA7425
Site Address: 760 Macadamia Drive
Conditional Use Permit# 07-02
Dear Ms Sexton:
Sprint Nextel would like to request an extension for the above referenced CUP for an additional ten (10) year term.
I am pleased to submit this Conditional Use Permit application package for City Department review.
Please accept the following items:
1. Completed Disclosure Statement P-1(A)(City Form)
2. Land Use Review Application P-1(City Form)
3. Storm Water Standards Questionnaire (City form)
4. Hazardous Waste and Substance Statement (City Form)
5. RF Compliance Letter
6. Check #12136029 in the amount of $315.00 for the renewal fee
7. Check #12151852 in the amount of $18.04 for the postage fee
8. Check #12080711 in the amount of $50.00 for the County of San Diego filing fee
9. 300' Radius Map and ownership labels
Should you require anything further, please don't hesitate to contact me directly at 704-930-1993 or
Heidi. Thorne@Ericsson.com.
rne
Representative for
el
Enclosures
(~~ CITY OF
~CARLSBAD
Memorandum
February 13, 2012
To: Chris Sexton, Assistant Planner
From: Tecla Levy, Associate Engineer
Via: Glen Van Peski, Senior Civil Engineer
Re: MCUP 07-02Xl, NORTH BATIQUITOS WCF
land Development Engineering has completed its review of the above referenced project.
Engineering staff does not have any comment to add to the project. Please add the following
condition of approval to the approving resolution or letter:
1. Developer shall comply with the City's Stormwater Regulations, latest version, and shall
implement best management practices at all times. Best management practices include
but are not limited to pollution treatment practices or devices, general housekeeping
practices, pollution prevention and educational practices, maintenance procedures, and
other management practices or devices to prevent or reduce the discharge of pollutants
to stormwater, receiving water or stormwater conveyance system to the maximum
extent practicable. Developer shall notify prospective owners and tenants of the above
requirements.
If you or the applicant has any questions regarding the above, please contact Tecla Levy at
extension 2733.
cc: File
Community & Economic Development
1635 Faraday Ave. I Carlsbad, CA 92008 I 760-602-2710 I 760-602-8560 fax I www.carlsbadca.gov
CITY OF CARLSBAD
REVIEW AND COMMENT MEMO
DATE: FEBRUARY 8, 2012
PROJECT NO(S): MCUP 07-02x1 REVIEW NO: 1 ~~~-----------------------------------~
PROJECT TITLE: NORTH BATIQUITOS WCF
APPLICANT: NEXTEL OF CA INC./SPRINT ERICSSON-HEIDI THORNE
TO: [gl Land Development Engineering-Terie Rowley
D Police Department-J. Sa sway
D Fire Department-Greg Ryan
D Building Department-Will Foss
D Recreation -Mark Steyaert
D Public Works Department (Streets)-Nick Roque
D Water/Sewer District
D Landscape Plancheck Consultant-PELA
D School· District
D North County Transit District-Planning Department
D Sempra Energy-Land Management
D Caltrans (Send anything adjacent to 1-5)
D Parks/Trails-Liz Ketabian
*ALWAYS SEND EXHIBITS
FROM: PLANNING DEPARTMENT
Please review and submit written comments and/or conditions to the PLANNING TRACKING DESK
in the Planning Department at 1635 Faraday Avenue, by 2/29/12. If you have "No Comments,"
please so state. If you determine that there are items that need to be submitted to deem the
application "complete" for processing. please immediately contact the applicant and/or their
representatives (via phone or e-mail) to let them know.
Thankyou /~ ·
COMMENTS: LD e-~urt~ ..,...t rM .~ • r X!-'
v\~. .,."' ~ ce>t\(M:~ of a.p~ ~
r 1 Date
PLANS ATIACHED
Review & Comment
cs
03/10
Sprint~
Topther with NEX1'B.
City of Carlsbad
1635 Faraday Avenue
Carlsbad, CA 92008
0
----------------······-····----
Sprint Nextel
6220 Sprfnt Parkway, KSOPHD0502-SB870
OYerfand Park, KS 66251
Offtce: (913) 315-1878 Fax: (913) 523·0436
January 26, 2012
0
DavlciiCirk
RF Engineer D
Regulatory Compliance
Attention: Planning Department
This is regarding Sprint Nextel's wireless telecommunication facility (Sprint
Nextel Site No. CA7425) located at 720 Macadamia Drive, Carlsbad, CA 92009.
Based on the results of a radio frequency ("RF") emission survey conducted for
Sprint Nextel, at the above mentioned address, the maximum reading of RF emissions
encountered, at the above mentioned location was 1.24% of the "Occupational
(Controlled) Standard." A wireless telecommunication facility is considered "compliant"
with the Federal Communications Commission's ("FCC") maximum permissible
exposure regulations if the readings are equal to or less than 100% of the standard.
You can learn more about the FCC rules and regulations specifically pertaining to
RF emissions by visiting the FCC website: www.fcc.gov/oet/rfsafety.
If you have any questions, please call me directly.
Sincerely,
David Kirk
National RF Engineering
NOTICE OF EXEMPTION
To: SD County Clerk
Attn: Linda Kesian
Mail Stop A-33
1600 Pacific Highway
San Diego, CA 92101
From: CITY OF CARLSBAD
Planning Division
1635 Faraday Avenue
Carlsbad, CA 92008
Subject: Filing of this Notice of Exemption is in compliance with Section 21152b of the Public
Resources Code (California Environmental Quality Act).
Project Number and Title: MCUP 07-02xl -North Batiquitos WCF
Project Location -Specific: .!..7"'-60"--"M..,a.,c""ad,.,a""m"'i"'a-'D"'r'-'-iv"'e'------------------
Project Location-City: ,C"'-ar'-"ls,_,b"'a,..d ___ _ Project Location-County: San Diego
Description of Project: A Minor Conditional Use Permit Extension to allow the continued
operation and maintenance of an existing Wireless Communication Facilitv CWCF).
N arne of Public Agency Approving Project: ,.C"'itv"'-'o'-'-f-"C"'a"'rl"'sb""a""d'----------==--=--=----=
1?0!1@@
Name of Person or Agency Carrying Out Project: Chris Sexton
Name of Applicant: Nextel of California
Applicant's Address: 6391 Sprint Parkway, Overland Park, KS 66251
Applicant's Telephone Number: 800-357-7641
Exempt Status: (Check One)
0 Ministerial (Section 21080(b)(l); 15268);
0 Declared Emergency (Section 21080(b)(3); 15269(a));
D Emergency Project (Section 21080(b)(4); 15269 (b)(c));
l::mes\ J Droncnbllrg. k. Re<:orJer Count) Clerk
MAR 2 9 2012
sv H. Ayuyao
DEPUTY
City of Carlsbad
MAY 0 1 2012
Community & Economic
Development Department
~ Categorical Exemption -State type and section number: ""E""xl,· s"'tin""g..._._F,ac""i""lit,.ie,s,__ ____ _
0 Statutory Exemptions-State code number: -----------------
0 General rule (Section 1506l(b)(3))
Reasons why project is exempt: Existing WCF involving negligible or no expansion.
Lead Agency Contact Person: Chris Sexton Telephone: (760) 602-4624
DON NEU, City Planner Date
Date received for filing at OPR:
Revised 06/10
r'iLED !N THE OFFICE OF THE COUNTY CLERK
San Diego County on __ _:.M;;,;..A:R 2 9 ..._£0 .... 1£_· -"--
Posted MAR 2 CJ.ZP1/ .Removed---~·
Ernest J. Dronenburg, Jr.
(1.
~·
COUNTY OF SAN DIEGO
ASSESSOR/RECORDER/COUNTY CLERK
ASSESSOR'S OFFICE
1600 Pacific Highway, Suite 103
San Diego, CA 92101-2480
Tel. (619) 236-3771 *Fax (619) 557-4056
www.sdarcc.com
RECORDER/COUNTY CLERK'S OFFICE
1600 Pacific Highway, Suite 260
P.O. Box 121750 *San Diego, CA 92112-1750
Tel. (619)237-0502 *Fax (619)557-4155
Transaction#: 268712020120329
Deputy: HA YUY AO
Location: COUNTY ADMINISTRATION BUILDING
29-Mar-2012 11:25 CITY OF CARLSBAD
MAR 2 g 2012
PLANNING DEPARTMENT
FEES:
50.00 Qty of 1 Fish and Game Filing Fee for Ref# 20120264
------
50.00 TOTAL DUE
PAYMENTS:
50.00 Check
50.00 TENDERED
SERVICES AVAILABLE AT
OFFICE LOCATIONS * Tax Bill Address Changes * Records and Certified Copies:
Birth! Marriage/ Death/ Real Estate * Fictitious Business Names (DBAs) * Marriage Licenses and Ceremonies * Assessor Parcel Maps * Property Ownership * Property Records * Property Values * Document Recordings
SERVICES AVAILABLE ON-LINE AT
www.sdarcc.com
* Forms and Applications * Frequently Asked Questions (FAQs) * Grantor/ Grantee Index * Fictitious Business Names Index (DBAs) * Property Sales * On-Line Purchases
Assessor Parcel Maps
Property Characteristics
Recorded Documents
State of California-The Resources Agency
DEPARTMENT OF FISH AND GAME
2012 ENVIRONMENTAL FILING FEE CASH RECEIPT
SEE INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARk:
LEAD AGENCY
CITY OF CARLSBAD
COUNTY/STATEAGENCY OF FILING
SAN DIEGO
PROJECTTITLE
MCUP 07-02X1-NORTH BATIQUITOS WCF
PROJECT APPLICANT NAME
NEXTEL OF CALIFORNIA
PROJECT APPLICANT ADDRESS
6391 SPRINT PARKWAY
PROJECT APPLICANT (Check appropriate box):
D Local Public Agency D School District
CHECK APPLICABLE FEES:
D Environmental Impact Report
0 Negative Declaration
CITY
OVERLAND PARK
0 Other Special District
D Application Fee Water Diversion (State Water Resources Control Board Only)
D Projects Subject to Certified Regulatory Programs
IZl County Administrative Fee
D Project that is exempt from fees
1Zl Notice of Exemption
D DFG No Effect Determination (Form Attached)
0 Other-------------------
PAYMENT METHOD:
D Cash 0 Credit 1Z1 Check D Other 12080711
SIGNATURE
X H. Ayuyao
RECEIPT#
SD2012 0264
STATE CLEARING HOUSE# (If applicable)
STATE
KS
D State Agency
$2,919.00
$2,101.50
$850.00
$992.50
$50.00
DATE
03/29/2012
DOCUMENT NUMBER
*20120264*
PHONE NUMBER
800/357-7641
ZIP CODE
66251
Ill Private Entity
$ ______ _
$ ______ _
$ ______ _
$ ______ _
$ $50.00 ____ _..:..... __
$ _______ _
TOTALRECEIVED $ ------'-$5_0_.0_0_
I TITLE
Deputy
11111111111111111111111111111111111111111111111111
ORIGINAL· PROJECT APPLICANT COPY-DFG/ASB COPY· LEAD AGENCY COPY· COUNTY CLERK FG 753.5a (Rev. 7/08)
• State of California-The Resources Agency
DEPARTMENT OF FISH AND GAME
2012 ENVIRONMENTAL FILING FEE CASH RECEIPT
S~E INSTRUCTIONS ON REVERSE. TYPE OR PRINT CLEARY
LEAD AGENCY
CITY OF CARLSBAD
COUNTYISTATEAGENCY OF FILING
SAN DIEGO
PROJECT TITLE
MCUP 07-02X1 -NORTH BATIQUITOS WCF
PROJECT APPLICANT NAME
NEXTEL OF CALIFORNIA
PROJECT APPLICANT ADDRESS
6391 SPRINT PARKWAY
PROJECT APPLICANT (Check appropriate box):
D Local Public Agency D School District
CHECK APPLICABLE FEES:
D Environmental Impact Report
D Negative Declaration
CITY
OVERLAND PARK
D Other Special District
D Application Fee Water Diversion (State Water Resources Control Board Only)
D Projects Subject to Certified Regulatory Programs
12J County Administrative Fee
D Project that is exempt from fees
0 Notice of Exemption
D DFG No Effect Determination (Form Attached)
D Other-------------------
PAYMENT METHOD:
D Cash D Credit 12J Check D Other 12080711
SIGNA lURE
X H. Ayuyao
l_
RECEIPT#
SD2012 0264
STATE CLEARING HOUSE #(lfappJicableJ
STATE
KS
D State Agency
$2,919.00
$2,101.50
$850.00
$992.50
$50.00
$
$
$
$
$
DATE
03/29/2012
DOCUMENT NUMBER
*20120264*
PHONE NUMBER
800/357-7641
ZIP CODE
66251
0 Private Entity
$50.00
$ ______ _
TOTALRECEIVED $ ____ --..:.$_50_._00_
J
11111111111111111111111111111111111111111111111111
ORIGINAL. PROJECT APPLICANT COPY-DFG/ASB COPY-LEAD AGENCY COPY ·COUNTY CLERK FG 753.5a (Rev. 7108)
•
NOTICE OF EXEMPTION
To: SD County Clerk
Attn: Linda Kesian
Mail Stop A-33
1600 Pacific Highway
San Diego, CA 921 01
From: CITY OF CARLSBAD
Planning Division
1635 Faraday Avenue
Carlsbad, CA 92008
Subject: Filing of this Notice of Exemption is in compliance with Section 21152b of the Public
Resources Code (California Environmental Quality Act).
Project Number and Title: MCUP 07-02xl-North Batiguitos WCF
Project Location-Specific: .!..7~60~M~a!!=c~ad~am~I~· a'-2D~n~·v.!..!e~----------------
Project Location-City: ~C~ar!.!lO!!sb~a~d~---Project Location-County: San Diego
Description of Project: A Minor Conditional Use Permit Extension to allow the continued
operation and maintenance of an existing Wireless Communication Facilitv CWCF).
Name of Public Agency Approving Project: ~C~itv~o:.:!:.f~C~ar~l~sb~a~d~----------=----
f?DI1~@
Name of Person or Agency Carrying Out Project: Chris Sexton l:mest J Dronenburg_ Jr .. Re\:order Count) Clerk
Name of Applicant: Nextel of California MAR 29 2012
BY H. Ayuyao
Applicant's Address: 6391 Sprint Parkway, Overland Park, KS 66251
Applicant's Telephone Number: .:::.8.!::..00~-.=:3.:::.5.:..7-~7..:::6....:.4~1 _________________ _
Exempt Status: (Check One)
D Ministerial (Section 21080(b)(l); 15268);
D Declared Emergency (Section 21080(b)(3); 15269(a));
D Emergency Project (Section 21080(b)(4); 15269 (b)(c));
181 Categorical Exemption -State type and section number: Existing Facilities
D Statutory Exemptions-State code number: -----------------
0 General rule (Section 15061(b)(3))
Reasons why project is exempt: Existing WCF involving negligible or no expansion.
Lead Agency Contact Person: Chris Sexton Telephone: (760) 602-4624
3-zr;;-!2
DON NEU, City Planner Date
Date received for filing at OPR:
Revised 06/10
DEPUTY
fiLED IN THE OFFICE OF THE COUNTY CLERK
San Diego COIJOty on __ M_AR_._2 9_Z_Ot2 __ _
Posted MAR 7 9 2017 Removed----
Returned to agency on ______ _
Deoutv H. Ay• 1yao
NOTICE OF EXEMPTION LJ FILE
To: SD County Clerk
Attn: Linda Kesian
Mail Stop A-33
1600 Pacific Highway
San Diego, CA 92101
From: CITY OF CARLSBAD
Planning Division
1635 Faraday Avenue
Carlsbad, CA 92008
Subject: Filing of this Notice of Exemption is in compliance with Section 21152b of the Public
Resources Code (California Environmental Quality Act).
Project Number and Title: MCUP 07-02xl -North Batiguitos WCF
Project Location-Specific: ~76~0~M~a~c:.!:!.ad~a:!!m~l~· a~D;:!J.n~·v!..!e:::......_ _______________ _
Project Location-City: .!:::C:!:!a:!..!rl;!:!.:sb~a~d!:__ __ _ Project Location -County: San Diego
Description of Project: A Minor Conditional Use Permit Extension to allow the continued
operation and maintenance of an existing Wireless Communication Facility (WCF).
Name of Public Agency Approving Project: .::::C~itvo:.z....::o:..:::.f....:::C::..::a=..:rl""sb""a=d::__ ___________ _
Name of Person or Agency Carrying Out Project: .!:::C~hri~·~s~S~ex!!:t~o:!!n'--------------
Name of Applicant: :..N::..:e:!.!x"'-"te'-!.l-'='o.!:..f..:::Co.::a~li.:::.::fo~rm~·~a'-----------·----------
Applicant's Address: 6391 Sprint Parkway, Overland Park, KS 66251
Applicant's Telephone Number: ~8~00~--=-3=-57,!_-..!..7~64~1!:__ ________________ _
Exempt Status: (Check One)
D Ministerial (Section 21080(b)(l); 15268);
D Declared Emergency (Section 21080(b)(3); 15269(a));
D Emergency Project (Section 21080(b)(4); 15269 (b)(c));
[8] Categorical Exemption -State type and section number: Existing Facilities
D Statutory Exemptions-State code number: -----------------
0 General rule (Section 1506l(b)(3))
Reasons why project is exempt: Existing WCF involving negligible or no expansion.
Lead Agency Contact Person: Chris Sexton Telephone: (760) 602-4624
3-20-/Z
DON NEU, City Planner Date
Date received for filing at OPR:
Revised 06/1 0
---~-~-----------------------------------------------
~-~ 0 0 FILE COPY
(_~~CITY OF
~CARLSBAD
3·5·/~
Community & Economic Development www.carlsbadca.gov
NOTICE OF REQUEST FOR A MINOR CONDITIONAL USE PERMIT
Notice is hereby given that a Minor Conditional Use Permit (MCUP) has been applied for to
allow the continued operation of a wireless communication facility consisting of 6 roof mounted
PCS panel antennas and one oval positioning antenna behind a screen and six ground-mounded
radio equipment cabinets on property generally located at 720 Macadamia Drive, on the north
side of Macadamia Drive between Raintree Drive and A venida Encinas Carlsbad, California, and
more particularly described as:
Lots 9 and 10 of Carlsbad Tract No. 81-05, filed in the Office of
the County Recorder of San Diego County, State of California,
April11, 1984
If you have any objections to the granting of this MCUP or wish to have an informal hearing to
discuss the requested MCUP, please notify the Planning Division, 1635 Faraday Avenue,
Carlsbad, California 92008, in writing within 10 days of the date of this notice. If you have any
questions, please call Chris Sexton in the Planning Division at (760) 602-4624.
CASE NO.: MCUP 07-02xl
CASE NAME: North Batiquitos WCF
DATE: March 5, 2012
CITY OF CARLSBAD
PLANNING DIVISION
~-; Planning Division
S;:-1635 Faraday Avenue, Carlsbad, CA 92008-7314 T 760-602-4600 F 760-602-8559 ®
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---_§)19?4 Thomgi._Bro~MOQ~
VICINITY MAP
SITE: 760 MACADAMIA DRIVE-CA7425
GC MAPPING SERVICE, INC.
3055 WEST VALLEY BOULEVARD
ALHAMBRA CA 91803
(626) 441-1080, FAX (626) 441-8850
GCMAPPING@RADIUSMAPS.COM
\
\
CITY OF CARLSS.
GC MAPPING SERVICE, INC.
3055 WEST VALLEY BOULEVARD
ALHAMBRA CA 91803
{626) 441-1080, FAX {626) 441-8850
gcmapping@radiusmaps.com
LEGEND
3 . OWNERSHIP NO.
OWNERSHIP HOOK
z
0
N
CASE NO.
DATE: 12-05-2011
SCALE: 1" = 100'
I HEREBY CERTIFY THAT THE PROPERTY OWNERS LIST AND LABELS SUBMITTED TO
THE CITY OF CARLSBAD ON THIS DATE REPRESENT THE LATEST AVAILABLE
iNFORMATION FROM THE EQUALIZED ASSESSOR'S ROLES.
APPLICATION NAME AND NUMBER
lloO mAC.p..dp..m ttA d (l ·
APPLICANT OR APPLICANT'S REPRESENTATIVE
BY: fJJc € CJ.l fo(&t(tTG. GU(~
DATE: 12 ... & .-"Z.o\1
RECEIVED BY
DATE: ____________________ _