HomeMy WebLinkAboutPD 16-20; BERTHA RESIDENCE ADDITION; Engineering Application(City of
Carlsbad
APPLICATION
ENGINEERING
PLANCHECK
E-23
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
Complete all appropriate information. Write N/A when not applicable.
Project Name: LttJt M'- f(tr&&.. o.rtcz Ak4A Date:R/zz/i
Project Description: --tc(
,
'r c-r'è LAJ
Project Address: 1 0 Z Z.- Aie.
Lot No(s).: Map No.: APN(s):Zo? '13 - 12-
Number of Lots:I Number of Acres: Miles of Trails:________________________
Owner: fflr.— Ir4(4c Applicant: VA aY\4r
Mailing Address: ?Z20 1- Mailing Address: 3446
CcJ1botA CA- Oio C-'-r14 ux
Phone Number: 76t 518 Phone Number: ?Lo
Fax Number: Fax Number:
E-mail: &J( E-mail: ?c.La t i,21recJh 4 .cc
I certify that I am the legal owner and that all the above
s e of my information d to the best knowledge. Tect
Signature: Date: Signature: UL Date: /tz /
Civil Engineer: Engineer: £4flcJL1 Soils Engineer: 1 It-&
Firm: Firm:
Mailing Address: 194 4 /(irk r. 414t 4 Mailing Address:
Phone Number: 1t'O L- Slk Phone Number:
Fax Number: Fax Number:
E-mail: LIL444 orts4S E-mail:
State Registration Number: CO" State Registration Number:
Additional Comments:
IMPROVEMENT VALUATION
What water district is the proposed project located in? (check one)
'CarIsbad Municipal Water District 0 Olivenhain Li Vallecitos
If in the Carlsbad Municipal Water District, what is the total cost estimate, including the 15% contingency 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)? $ O
GRADING QUANTITIES
cut cy fill _______ cy remedial cy import _______ cy export O cy
E-23 Page 1 of 2 REV 07/14 PI) I & '-2o
L
City of
Carlsbad
APPLICATION
ENGINEERING
PLANCHECK
E-23
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
Complete all appropriate information. Write N/A when not applicable.
APPLICATION FOR
(check all that apply)
FOR CITY USE ONLY
Project
I.D.
_________ Drawing
Number
Deposit /Fees
Paid
Comments
LI Adjustment Plat (ADJ)
El Certificate of Compliance (CE)
0 Dedication of Easement (PR)
Type:
Type:
El Encroachment Permit (PR)
LI Final Map (FM)
E 'Grading Plancheck (DWG) '3 . -
O Improvement Plancheck (DWG)
0 Parcel Map (PM)
0 Quitclaim of Easement (PR)
Type:
LI Reversion to Acreage (RA)
LI Street Vacation (SW)
LI Tentative Parcel Map (MS)
LI Certificate of Correction (CCOR)
LI Covenant of Easement (PR)
LI Substantial Conformance
Exhibit (SCE)
LI Trails LI <mile LI > mile
'Other tt._Q -O m u ',-
APPLICATION ACCEPTED B1,1/2
JJ ,
DATE STAMP
APPLICATION RECEIVED
E-23 Page 2 of 2 REV 07/14
(City of
C&I.Sbad
APPLICATION
GRADING PERMIT
E-24
Development Services
Land Development Engineering
1635 Faraday Avenue
760-602-2750
www.carlsbadca.gov
I PERMIT NUMBER: (42,Qj(p _(x23 I
Project Name: ,&ppi-rw,cj Project Number:
Project Location: Location: io'-'- Drawing Number: fc37 —'TA
Assessor Parcel Number(s):
Project Description:Apoivvkj a"P (pJYr-
Owner: A w3vtzr , 3, e')
Address: '3zzO (, Suite:
City: State: Zip: 9_!I0
Phone Number: U) c43 -P2 f'p. Jpc,,ir'' Fax Number:
I certify that I am the legal owner of this prop authorize the grading associated with this ermit. 01 OWNER SIGNATURE: DATE:
Civil Engineer: e..i4# j2-c C, - LA,vc> r41w-6, Ale-
Address: •j)34 LA t1zt P'1a4v Suite: 14 City: fflAc State: 4 Zip: ZOJ'(
Phone Number: (7 ,) 7j, #23'Z Fax Number:
Soils Engineer: ijc. y-,
Address: i'P* ro',956rr?A %JtJ Suite:
City: V ,'r,- State: c- Zip:
Phone Number: f70) - Fax Number:
Grading Contractor: .prMoç Seric State License No.:
City Business License No.:
'ç.. Address: rtco Suite:
City: State: A Zip: g 0g
Grading Quantities: cut cy fill cy import cy
remedial cy export cy
Qualified contact person trained in NPDES requirements:
Phone Number: ci(,O) i3 /3
Basis of Permit Fees: cy Total Permit Fees: $
Verified By: Balance Due: $
I hereby acknowledge that I have read the application and information provided is correct. I agree to comply with all
federal, state, and city laws, ordinances, regulations and policies relating to excavation and grading including, but not
limited to, the Federal Endangered Species Act of 1973 and any amendments thereto. I will also comply with OSHA
Permit requirements for trenches over five feet deep and the provisions and conditions of any permit issued pursuant to
this application.
Applicant Name:
Address: Suite:
City: State: Zip:
Phone Number: .- Fax Number:
APPLICANT'S SIGNATURE: DATE:
-
E-24 Page 1 of 1 REV 07/14