HomeMy WebLinkAboutCDP 02-42; DUNN RESIDENCE; Engineering Application' --<.,.... ' • .. CITY OF CARLSBAD -ENGINEERING DEPARTMENT
APPLICATION
RIGHT-OF-WAY PERMIT APPLICATION
JOB ADDRESS: d..Jzcr---~~ ~
NEAREST CROSS STREET: =;=:-~ ~ w:
ASSOCIATED PROJECT NO.: ·~ U)9Qf--4:1ASSESSOR PARCEL NO(S): J.rj;,. Q .. f/ -.Ji
DRAWING NO. (if applicable):
BRIEF DESCRIPTION OF WORK:
CONTRACTOR (Permittee)
NAME (Print or Type):
CONTACT PERSON:
MAILING ADDRESS:
PHONE NUMBER:
24 HOUR EMERGENCY TELEPHONE: ~J~e -QA' ?&Q --J/y/...,:-f(ftLf
STATE CONTRACTOR'S LICENSE NUMBER: --'{_=··~ ..... c--· _·er_...,4?='~:.-d=·=(_~-"'--;)..&,.?_· ________ _
STATE CONTRACTOR'S LICENSE TYPE:
CITY OF CARLSBAD BUSINESS LICENSE NUMBER:
By its signature below, permittee agrees to indemnify, hold harmless, and defend the City of Carlsbad or
its officers or employees from all claims, damage or liability to persons or property arising from or caused
by an activity or work done pursuant to this permit unless the damage or liability was caused by the sole
active negligence of the City or its officers or employees. This agreement is a condition of the issuance
of a right-of-way permit.
SIGNATURE DATE
The same name must appear on this application, the Cash Security Agreement and the
request for refund as the Permittee.
CITY USE ONLY
PERMIT NO.:
ENTERED INTO COMPUTER BY:
TCP APPROVED BY: DATE: ------
INSURANCE CHECKED BY: EXP. DATE: ---------
H:\Development Services\MASTERS\FORMS -\APPLICATIONS ·\RIGHT OF WAY PERMIT Packet.doc
RECEWED
MAR 20 2006
ENGINEERING
DATl[)f~MENT
APPLICATION RECEIVED
C lYP 02-
, -•, r,1~,;
PROJECTADDRESS:_a~~-_L.~ezf::.~~:..-<~---------------~----.----
LOT NO(S),: -------------------APN(S).:
NUMBER OF LOTS: NU M !3 ER OF ACRES: _.£..x..:.;:~-L-..a..i~:!.._----
OWNER: APPLICANT:
Mailing Address: Mailing Address: &x: £2r/
Phone Number:
Fax. Number:
.E-Mail:
.I certify that I am the legal owner and that all the above
information Is true a d correct to the best of my knowledge.
Mailing Address:
Phone Number:
· Fax Number:
.E-Mail:
. State Registration Number:
ADDIDONAL COMMENTS:
Phone Number:
Fax Number:
E-Mail:
FIRM:
Mailing Address:
Phone Number:
Fax Number:
E-Mail:
State Registration Number:
----IMPROVEMENT-VALUAT-ION--::::::;::======================-=-""1
1. What water district is the proposed project located in? (check one)
Ocarlsbad Municipal Water District · Oonvenhain Ovallecitos
2, if in the Carlsbad Municipal Water District, wh;;it 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)? · · $
GRADING QUANTITIES
cut g cy fill H cy remedial % cy import .ff cy export _e,----cy
-SEE .REVERSE SIDE
H:/DEVELOPMENT SERVICES/MASTERS/Application for Engineering Plan Check C, l) p O 2 -'f'f!ievised 1/14/02
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, .. , ,,.' ', :':,. "i_ ,, -··::-:· AP~LICATION' I ,._·,,· ,,,_
, , . '· ,• . EN(t[NEEIUNG p·i.A·1tc:HECK ' ·
-. . , _.: . ~o~p,et~-all ~pp.r9pri~_te inf9r~a~iori~ -~.,ii~ ~j~-wh~~ ~~t !~p_pli~~le~ :, ' : ~ :·';
APPUCATION FOR
( v' all that apply)
D Adjustment Plat (ADJ)
D Certificate of Compliance (CE)
D Dedication of Easement (PR)
Type.;.,: _____ ~_
Type.;.,: ______ _
Type:
-. -, PROJEdt'' DRAWING' ·: ' DEPQ$U1-FE'E$ '. . c;:ot,,,ME~rs.· : -· _j,i,,,:,\:-·, NO~~ER :'_, -.,~Ii),'':.:-'. : .
/
· · D Encorachment Permit (PR)
· D Final Map (FM)
.O Grading Plancheck (DWG)
D Improvement Plancheck (DWG)
D Parcel Map (PM)
D Quitclaim of Easement (PR)
Type: -------
D
Type.;.,: ---------
Type:
Reversion to Acreage (RA)
.D Street Vacation (STY)
', ',,'
D
D
D
D
Tentative Parcel Map (MS)
:certificate of Correction
(CCOR)
Covenant of Easement (PR)
Substantial Conformance
Exhibit (SCE)
/
D Other
·,. :·, ,'J( ',, ;1, '. r,, ,,,,1' ,'' ·\" .. ,_,, .,,.
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'. :· ~' .
··-~-· .•• , '','\..~~.'~·--,~ "-~·' •,• . .i•i ,, •' ., ,, ....... ,., •• ,,
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. ' -' 'l).A"t'I;--STAMP,,' : ' .. · ,.: , :·-APPJ..ICATQr,t,; R~C:l;IV~P : .. ,
IJ•/n<=\IFI nPUFIJT 1':FRl/lr.F!':IUA!':TFR!;/Annllt'Jlltlnn fnr FnnlnAArinn Pl11n Check Paae 2 , Revised 1 /14/02
PROJECT ADDREss: . · HthHLAN12 Die,va
LOT NO(S).:/?oacNWY4'5eftMAP No~:S§c_ -s&rosR 4~PN(S).:
NUMBER OF LOTS: NUMBER OF ACRES:
OWNER:
Mailing Address: ~1....1:~;i,..::....L.1.~.:::L..=...;.__.1---
Phone Number:
.Fax Number:
.E-Mail:
I certify that I am the legal owner and that all the above
· est of my knowledge.
APPLICANT:
Mailing Address:
Phone Number:
Fax Number:
' . ' ' I E-Mail: l,
Signature: Date:
SOil.S ENGINEE:R: \1NC[t; si A11@Ll! tt2N 'i.1-16
FIRM: 5.Me/.J o 1 '5~~ If!~
Mailing Address: . · ~5' J J A-!20 /J )11!
Phone Number:
Qe_j.A /GI Ot;-C;!i 92054-
. 16Q-4s1-z<r,o 1-
-e~CPNri,ao ~A ,:zozo/ > 7b0-74'3-J 2-14-Phone Number:
Fax Number: Fax Number: 7b(2-73e,-034J
E-Mail: E-Mail:
State Registration Number: )Z~ S-: Z 3 0 SD State Registration Number: \ZC..c 4{ I 74:
. .
ADDm0NAL COMMENTS:
IMPROVEMENT VALUATION
1. What water district is the proposed project located in? (check one)
Ocar1sbad Municipal Water District . .Oouvenhain Ovallecitos
2. 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)? · ·$
GRADING QU~NTITIES
cut bZ't cy fill 1..4b1ct remedial /OIJ fl cy import/84O cy export ___ cy
>' ,t'
' ' '~ . ' '
• " . . y· .. ._:•. :·. ":. :-:· ···fOR ·cm .. USE ONLY' ... ,,_
APPl:,.ICATION FOR
( ~ all that apply)
PROJECT
· '·· I.D;
DRAWING_. DEPOSIT/FEES COMMENJS
NUMBER-. P~ID .
D Adjustment Plat (ADJ)
D Certificate of Compliance (CE)
D Dedication ofEasement (PR) .... • _________ -..,. ______ _
Type_: ------·
Type_: _________ _
Type:
D Encorachment Permit (PR)
D !jPa!Map(FM)
[j"' Grading Plancheck (DWG)
D Improvement Plancheck (DWG)
D Parcel Map (PM)
D Quitclaim of Easement (PR)
Type: --------
Type_:--------,
'I
,Type: !l--_;_:,-=======--J::====:!=====;:======I D Reversion to Acreage (RA)
D · Street VaGation (STV)
D. Tentative P_a(~el Map (MS)
D Certificate of Corrediori
(CCOR)
D Covenant of Easement (PR)
D · Substantial Conformance
Exhibit (SCE)
D Other
·. '
'. ·. ,,
,, -, .. ., '.
.. ..
,, ,, , '• ·11 ....... '•
~ :, '.
·-.
·.RECEIVED
, .. ·:1
. ·Ju L o 2 2004 ·
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ENGINEERJNd · . .-: ...
. _ DEPARrMENT ., ,.
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