HomeMy WebLinkAboutCD 2017-0011; VERIZON WIRELESS LA COSTA OAKS; Administrative Permits (ADMIN)CITY OF CARLSBAD APPLICATION FORM FOR CONSISTENCY DETERMINATION APPLICATION
CITY USE ONLY
Original Project Number:tbiedtkp 'IS—My Consistency Determination Number:CDS()ti --•0011
PROJECT NAME:Verizon: La Costa Oaks (OMWD -Denk Reservoir)
Assessor's Parcel Number(s):223-617-25-00
Description of proposal (add attachment if necessary):Conform to previously approved MCUP by T-Mobile for (2) stealth
design mono-trees and associated compact MCE equipment at grade.
Yes M NoWould you like to orally present your proposal to your assigned staff planner/engineer?0
Please list the staff members you have previously spoken to regarding this project.If none, please so state.
Austin Silva
OWNER NAME (Print):Olivenhain Municipal Water District APPLICANT NAME (Print): Verizon Wireless
MAILING ADDRESS:1966 Olivenhain Road MAILING ADDRESS:15505 Sand Canyon Avenue
CITY, STATE, ZIP:Encinitas, CA 92024 CITY, STATE, ZIP:Irvine, CA 92
TELEPHONE:760-753-6466 TELEPHONE:949-289-7000
EMAIL ADDRESS:Attn: George Briest EMAIL ADDRESS:
*Owner's signature indicates permission to conduct a preliminary
review for a development proposal.
IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
NECESSARY FOR MEMBERS OF CITY STAFF TO INSPECT AND OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE
ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS AND CORRECT TO THE BEST OF MY KNOWLEDGE.
APPLICATION.I/WE CONSENT TO ENTRY FOR THIS PURPOSE.I
CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE.
see LOA by G.Briest date 3/23/17
SIGNATURE DATE SIGNATURE DATE
APPLICANT'S REPRESENTATIVE (Print):Plancom Inc.
MAILING ADDRESS:.302 State Place
CITY, STATE, ZIP:Escondido, CA 92029
TELEPHONE:760-587-3003 RECEIVED
EMAIL ADDRESS:kerrigan.diehl@plancominc.com MAY 04 2017
I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE APPLICANcafflOk gaREGgiAll INFORMATION IS TRUE AND
CO T TO THE BEST PLANNING DIVISION
N Tar-.T April 2.51 2017
SIG DATE
FEE REQUIRED/DATE FEE PAID:v .cv 51 9 11.9.
RECEIVED BY:C-4.244
P-16 Page 2 of 2 Revised 08/16