HomeMy WebLinkAboutMCUP 10-01; T-Mobile SD06224A Innovative Time; Conditional Use Permit (CUP) (3)ENVIRONMENTAL INFORMATION FORM
(To be Completed by Applicant)
Date Filed: (To be completed by City)
Application Number(s):
General Information
1. Name of Proiect~T~ Mob| (f St)Q 6 SQM "£v\f\&\IO^V£ ~T
2. Name of developer or project sponsor: 1 I i iQVO I V^5*^
Address:
City, State, Zip Code: *- j CLr\
Phone Number: frSo ^" 3S^f "" L0 [
3. Name of person to be contacted concerning this project: rj_^^,£JiO>-/ tj^ I
Address: j"7M7
City, State, Zip Code: ;
Phone Number: " "
4. Address of Project:
Assessor's Parcel Number:
5. List and describe any other related permits and other public approvals required for this project, including
those required by city, regional, state and federal agencies:
6. Existing General Plan Land Use Designation:
7. Existing zoning district:
8. Existing land use(s): _^
9. Proposed use of site (Project for which this form is filed):
Project Description
10. Site size: 10 A.
11. Proposed Building square footage: NJ | rT
12: Number of floors of construction: M I ' \
13. Amount of off-street parking provided:
02/22/06
14. Associated projects:
15. If residential, include the number of units and schedule of unit sizes: (VJ / *\
16. If commercial, indicate the type, w.he.thej- neighborhood, city or regionally oriented, square footage of sales
area, and loading facilities:
17. If industrial, indicate type, estimated employment per shift, and loading facilities:
18. If institutional, indicate the major function, estimated employment per shifty£stimated occupancy, loading
facilities, and community benefits to be derived from the project: fr.j / r"\
19. If the project involves a variance, conditional use or rezoningapplication^ state this and indicate clearly
flVl D4- QjJuP ~why the application is required:
Are the following items applicable to the project or its effects? Discuss all items checked yes (attach additional
sheets as necessary).
Yes JNo
20. Change in existing features of any bays, tidelands, beaches, or hills, or | |
substantial alteration of ground contours.
21. Change in scenic views or vistas from existing residential areas or public | |
lands or roads.
22. Change in pattern, scale or character of general area of project. | | \3c
23. Significant amounts of solid waste or litter. | |
24. Change in dust, ash, smoke, fumes or odors in vicinity. Q
25. Change in ocean, bay, lake, stream or ground water quality or quantity, or | |
alteration of existing drainage patterns.
26. Substantial change in existing noise or vibration levels in the vicinity. Q
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Yes No
26. Site on filled land or on slope of 10 percent or more. | |
28. Use or disposal of potentially hazardous materials, such as toxic | |
substances, flammables or explosives.
29. Substantial change in demand for municipal services (police, fire, water, | |
sewage, etc.).
30. Substantially increase fossil fuel consumption (electricity, oil, natural gas, | | f>c
etc.).
31. Relationship to a larger project or series of projects. | |
Environmental Setting
Attach sheets that include a response to the following questions:
32. Describe the project site as it exists before the project, including information on topography, soil stability,
plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on the
site, and the use of the structures. Attach photographs of the site. Snapshdts or Polaroid photos will be
accepted.
33. Describe the surrounding properties, including information on plants and animals and any cultural,
historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land
use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height,
frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots or polaroid photos will
be accepted.
Certification
I hereby certify that the statements furnished above and in the attached exhibits present the data and information
required for this initial evaluation to the best of my ability, and that the facts, statements, and information presented
are true and correct to the best of my knowledge and belief.
Date: /// / O~{ Signature:
For: TMob'l (g.
02/22/06