HomeMy WebLinkAboutPR 4.32; ANTHONY PERAINO; Engineering Application/
CITY OF CARLSBAD A ENGINEERING DEPARTMENT A ABOV~OUND ENCROACHMENT-PERMIT APPL~TION
PERMIT No. I fr<. 4~3/L, I PROJECT NAMEI 1/Pl/,oM'J rtlf)///.Jd I '-'-'-'---"-'----(l..;,-1 ----';..;;=-:'-'-'----'---------'
LOCATION OF PROJECT: ON THEI .---,}_...o_v_t_k __ lsrnE OFI eAs.S W60.\\ )T I~
(NORTH, SOUTH, EAST, WEST) (NAME OF STREET)
BETWEEN I B1-LL2 LAt.v'L I AND --.__I ___,;:..;J)=o-.:::c(l'-'-'1lJ"'--'A:'-"-----'~""--,....__ __ __,
(NAME OF STREET) {NAME OF STREET)
ASSESSOR PARCEL NO(S) .1...-_d_0_.S ____ / _(n_O __ d_3 __ t)_0 ____________ __,
BRIEF_ DESCRIPTION OF ENC_ ROACHMENT: I '1 •I ( )ff th
o+ C!u te_ h AM /"I acDPftc 7t1 j_,,<./t.
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REASON FOR ENCROACHMENT:
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OWNER
MAILING ADDRESS
2,./t>S' 6 &"Swo-a-D /9-t/e
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APPLICANT
NAME (PRINT OR TYPE)
5"9/1-1€
MAI~ING ADDRESS
CITY AND STATE ZIP TELEPHONE
C
I CERTIFY THAT I AM THE LEGAL -OWNER AND THAT I CERTIFY THAT I AM THE OWNER'S REPRE-ALL THE ABOVE INFORMATION IS TRUE AND CORRECT SENTATIVE AND THAT ALL THE ABOVE TO THE BEST OF MY KNOWLEDGE. INFORMATION IS TRUE AND CORRECT TO SIGNATURE DATE i'HE BEST OF MY KNOWLEDGE.
0 _Z{;-!7cJ SlGNATURE DATE
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FOR CITY USE ONLY
TOTAL FEE REQURIED,-_\_e() ___ QD_· ----,
APR 301990
oATE FEE PAID I ~ (?fJ/vio I
RECEIPT NO. r~cr1 '?'2--f I·
VED
RECEIVED BY: