HomeMy WebLinkAboutCP 272; GOLDBERG, TED; Condo Permit (CP)APPLICATIO&I
Ozone Change o Minor Redevelopment Permit OGeneral Plan Amendment 0 Precise Development Plan []Tentative Tract Map OSpecific Plan OPlanned Unit Development 0 Site Development Plan
rMinor
jor Condominium Permit 0 Conditional Use Permit ) Condominium Permit 0 Variance OMaster Plan OPlanning Commission Determination []Major Condominium Conversion 0 Special Use Permit
L— OMajor Redevelopment Permit DAdministratjve Variance (check other boxes if appropriate)
L )Dmplete Description of Project (attach additional sheets if necessary)
op
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- location of Project
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Ieal Descri tion ( mplete) -. ci 's \ C c 5 \\ \\ \\ \ J \ Assessors Parcel Number
_\ \\ —- --- Zone General Plan Existing Land Use
roposed Zone Propo age Proposed General Plan Site Acreage
0 Owner Applicant ) ame (Print or Type) Name (Print or Type) \\\
\\ k\ Mailing Address Mailing Address
•City and State Zip Telephone City and Stat'è Zip Telephone
r \\ \\\\ __
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TIFY THAT I AM THE LEGAL NER AND I CERTIFY THAT I AM THE OWNER'S REPRESENTATfl ALL THE ABOVE IS TRUE AND THAT ALL THE ABOVE INRDRMATICq IS TRUE
ORRECT '10 THE BEST OF MY KNOWLEDGE. AND CORRECT '10 THE BEST OF MY KNOWLEDGE.
4-
If after the information you have submitted has been reviewed, it is deterrnned
that further information equired, you will be so adv..
APPLICANT: R A~\
Name (individual, partnership, joint venture, corporation, syndication
Business Address
•\•
Telephone Number - - -
AGENT:
• Name
Business Address -
Telephone Number •
XEDMERS
• •• S\
Name '(individual, partner, joint • Uome Address •
venture, corporation, syndication)
•
• • Business Address '
\\\ \
0
Telephone Number Telephone Number
• Borne Address
Business Address
Telephone Number - Telephone Number
(Attach more sheets if necessary)
I/We declare under penalty of perjury that the information contained in this dis-
closure is true and correct and that it will remain true and correct and may be
relied upon as being true and correct until amended. -
Applicant J
- BY \\k
0 Agent, C:ner, Partner •
APPLICANT DISCLOSURE FORM
In order to assist the members of the Planning Commission and
City Council to avoid possible conflicts of interest, all appli-
cants are required to complete this disclosure form at the time
of submitting their application. When this form has been com-
pleted and signed, the information will be relied upon by them in
determining if a conflict may exist, so please ensure that all of
the information is completed and accurate. If at anytime before
a final action on your application has been rendered, any of the
information required by this disclosure changes, an amendment
reflecting this change must be filed.
If the applicant is an individual, or a partnership (either gen-
eral or limited) or a joint venture, please state the full name,
address and phone number of each person or individual (including
trusts) who own any beneficial interest in the property which is
the subject of this application. Should one or more parties to
the application be a partnership or joint venture, then please
state the full legal name of the partnership or joint venture,
its legal address and the name and address of each individual
person who is a general and/or limited partner or member of the
joint venture.
Should one or more of the parties be a privately held corporation
(10 shareholders or less) or a real estate syndication, then
please state the state of incorporation or syndication, corporate
number, date of incorporation or syndication, corporate or syn-
dicate address, and the full names and addresses of each
individual shareholder or syndicate member. Should the corpor-
ation be a publically held corporation, then state the full name
and address of the corporation, the place of its incorporation,
number of shareholders, and the name and address of the officers
of the corporation.
Should you feel that additional information needs to be provided
in order to provide a full disclosure, please include it.
I N 0
STATEMENT OF AGREEMENT
TENTATIVE SUBDIVISION MAP
CITY OF CARLSBAD
The Subdivision Map Act and the Carlsbad Municipal Code sets a
fifty (50) day time restriction on Planning Commission processing
of Tentative Maps and a thirty (30) day time limit for City
Council action. These time limits can only be extended by the
mutual concurrence of the applicant and the City. By accepting
applications for Tentative Maps concurrently with applications
for other approvals which are prerequisites to the map; i.e.,
Environmental Assessment, Environmental Impact Report, Condominium
Plan, Planned Unit Development, etc., the fifty (50) day time
limits and the thirty (30) day time limits are often exceeded.
If you wish to have your application processed concurrently,
this agreement must be signed by the applicant or his agent. If
you choose not to sign the statement, the City will not accept
your application for the Tentative Map until all prior necessary
entitlements have been processed and approved.
The undersigned understands that the processing time required by
the City may exceed the time limits, therefore the undersigned
agrees to extend the time limits for Planning Commission and
City Council action and fully concurs with any extensions of
time up to one year from the date the application was accepted
as complete to properly review all of the applications.
ignature
ame (Print)
Date
SAV,41'r- CoLcL toe7
Relationship to Application
(Property Owner-Agent)
FORM: PLANNING 37, REVISED 3/80
•PEEMENrAL INEORMATIOT FORM •
S. VARIANCE
1) Gross Acres (or s.iare footage, if less than acre) \S'\
2) Zane
3) General Plan Land Use Designation
4) By law a Variance may be approved only if certain facts are found to exist.
Please read thase requirements carefully and explain how the proposed
project meets each of these facts. Use additional sheets if necessary.
a) Explain why there are exceptional or extraordinary circumstances or
conditions applicable to the property or to the intended use that do not
apply' generally to the otir property or class* of use in 'the same vicinity -.
and zaie: -
b) Explain why such variance is necessary for the preservation and
enjoyment of a substantial property right: possessed by other property in
the same vicinity and zone but which is denied to the property in question:
c) Explain why the granting of such variance will not be materially
detrimental to the public welfare or injurious to the property or
improvements in such vicinity and zone in which the property is located
d) Explain why the granting of such variance will, not adversely affect the
conprehansive general plan:
FILING REQUIREMENTS
I. SPECIFIC REQUIREMENTS
General Plan Amendment/Zone Change
1. Application Form
2. General Requirement Items W-Q
3. Reproducible 1:500 scale map of subject property
showing requested zoning and surrounding zoning and
land uses.
4. Fee: General Plan Amendment $200.00 + $5.00 per lot or
acre. Zone Change: $500.00
Master Plan/Specific Plan/Precise Development Plan
1. Application Form
2. General Requirement Items:
- thirteen (13) copies of items A-D
- items E-Q
3. Fee: Master Plan $1,000 + $2.00 per/acre
Specific Plan $1,000.00
Master Plan Amendment: Minor $50.00 + 2.00 acre
Major $500.00 + 2.00 acre
Tentative Tract Map
2. Thirteen (13) copies of the Tentative
1. Application Form
3. General Requirement Items
- thirteen (13) copies of items A-C
- items 5, G-K, M-R
4. Fee: $500.00 (1-25 lots or units)
$750.00 (26-100 lots or units)
$1,000 (100 + lots or units)
Extension: 1/2 of original fee
regular fee on Revision: 1/4 of tentative map and
additional lots or acres.
Major planned Development (5 or more units)
T-.-Application Form
2. General Requirement Items:
- thirteen (13) copies of items A-
- items E-Q
3. Conversion to Condominiums - list of names and
addresses of all tenants of the project, proof of
notification of the tenants 60 days prior to filing
tentative map.
4. Fee: $200.00
$5.00 per unit for notification of tenants
NOTE: Tentative Tract Map Required
-Mnor_Planned Di'velopn'ent (4 or less units)
1. AppI icatwn t'orm
2. General Requirement Items:
- ,three (3) copies of items A-D
- iteu's K, L, 0, P, Q
3. Conversion to Condominiums - list of names and addresses of
all tenants of the units to be converted to condominiums.
4. Fee: $50.00 + $1.00 per unit
NOTE: Tentative Parcel Map Required
Site Development Plan
1. Application Form
2. General Requirement Items
- thirteen (13) copies of items A-D
- items E-L, 0, P, Q
3. Fee: $350.00
Conditional Use Permit/Special Use Permit
1. ATttion Form
2. General Requirement Items:
- thirteen (13) copies of items A-D
- items E-Q (items M,N & 0 not required for Special Use
Permit)
3. Fee: $400.00
Planning Commission Determination
T. Application Form
2. One page statement precisely indicating the determination
request.
3. General Requirement Items:
- thirteen (13) copies of items A and D
- items H, K, and L
4. Fee: $25.00
Administrative Variance
1. Application Form
2. General Requirement Items:
- (3) copies of items A & D, if applicable
- items G, H, 3-N, and P
3. Fee: $100.00
Mj2r and Minor Redevelopment Permits
1. ApplicaCion Form
2. General Requirement Items:
- thirteen (13) copies of Item A-O
- items (Major) E-N, P, K (if applicable) material
samples.
- items (Minor) E-H, 3-N, P, material samples
3. Fee. (Not established except where other permit is
necessary).
Variance
1. Application Form Tract Map 2. General Requirement Items:
- thirteen (13) copies of item A
- items E, G, H, 3-N, I if applicable, and P
(see Title 19. Environment)
3. Variance Supplemental Sheet
4. Fee: Single Family $100.00
Other - $250.00
.
0
Q?-)~
GENERAL REQUIREMENTS E. One () copy of colored site plan (24"x36")
F. One (1) copy of colored elevations (24 1lx36")
A. Site Plan: Shall include the following information: G. One (1) copy each of 8 1/2"xll" site plan and elevations.
- Name and address of applicant, engineer and/or H. One (1) copy of -8 1/2"xll" location map (suggested scale
architect, etc. 1:200" vicinity maps on the site plan are not acceptable)
- All easements I. Environmental Impact Assessment Form ($100)
- Dimensioned locations of: J. Public Facility Agreement: 2 copies: One (1) notorized
access, both pedestrian and vehicular, showing original, One (1) reproduced copy.
service areas and points of ingress and egress Disclosure Statement
off-street parking and loading areas showing Photostatic copy of deed with complete legal description of
location, number and typical dimension of spaces, - subject property or other form of description acceptable to
and wheel stops. the Land Use Planning Manager.
- distances between buildings and/or structures M. Property Owners' List and Addressed Stamped Envelopes
- building setbacks (front, rear and sides) (Not needed for Site Development Plan, Special Use Permit
- location, height, and materials of walls and fences and Minor Condominium Permit) 1). a typewritten list of the
- location of freestanding signs names and addresses of all property owners and occupants
- all driveways to scale on adjacent and across the within a 300 foot radius of subject property. The list
street properties for a distance of 100 feet beyond shall include the San Diego County Assessor's parcel number
the limits of subject site. from the latest assessment rolls. 2) Two separate sets of
- existing curbs, gutters, sidewalks and existing legal size, addressed stamped envelopes (four sets for
paving widths within 100 feet on adjacent and across condominium conversions) of the property owners and
4or the street properties. occupants within a 300-foot radius of subject property.
- typical street section any address other than single family residence, apartment or
- any existing median islands within 100 feet of suite number must be included. DO NOT TYPE ASSESSOR'S
subject site. PARCEL NUMBER ON ENVELOPES AND LEAVE RETURN OF ADDRESS
- nearest cross streets on both sides with plus or BLANK. 3) For Condominium Conversions, two separate sets of
minus distances from subject site. addressed, stamped envelopes of all existing tenants is
- location of all buildings within 100 feet of subject required.
properties. N. 300 Foot Radius Map
- a vicinity map showing major cross streets (Not needed for Site Development Plan, Special Use Permit
- a summary table indicating the following and Minor Condominium Permit). A map to scale not less than
information: 1" = 200' showing each lot within 300 feet of the exterior
site acreage boundaries of the subject property. Each of these lots
existing zone and land use shall be consecutively numbered and correspond with the pro-
proposed land use perty owner's list. The scale of the map may be reduced to
total building coverage a scale acceptable to the Land Use Planning Manager if the
building sq. footage required scale is impractical.
percent landscapinq 0 For residential projects within Vista, Encinitas or San
number of parking spaces Dieguito School Districts, the applicant shall indicate
sq. footage of open/recreational whether he prefers to dedicate land for school facilities,
space (if applicable) to pay a fee in lieu thereof, or do a combination of th
cubic footage of storage space If the applicant prefers to dedicate land, he shall sug 0 (if applicable) the specific land.
II.
B . Preliminary Grading and Drainage_Plank (24"x36")
- existing and proposed contours on the site and within
100 feet of the boundaries of the site.
- elevations of the site
- existing on-site trees; those to be removed and those
to be saved.-
C. Preliminary-Landscape and Irrigation Plank (24"x36")
-
location of planting areasThnd typical plant materials
(quantity and size)
- location of areas to be irrigated
For residential projects within the Carlsbad Unified School
District and the San Marco Unified School District, the
applicant shall submit written confirmation that school
facilities will be available and serve the project at time
of need.
Preliminary Title Report
Proof of sewer availability if located in the Leucadia
County Water District.
R. Statement of agreement to waive tentative tract map time
limits.
*NOTE: ALL EXHIBITS MUST BE FOLDED IN A SIZE NOT TO EXCEED
8 1/2"x1l".
D. Building Elevations and Floor Plans* (24"x36M)
- floor plans with square footages included
- location and size of storage areas
- all buildings, structures, walls and/or fences, signs
and exterior lights.
:
ALIFORNI p WO D TI ECOMPANY
P.O.BOX A-1631 • SAN DIEGO CALIFORNIA 92112 - • (619)278-4171
a-PRELIMINARY REPORT
TD EOLDEtC
2311 VIA APLLLA
DL AR,CA ----- ----- -
Date 17, 94 Attention: Your No. TEDCOLDER.G
Our No. 71024-04
Jf4UAT 13 84 Dated as of .................................19 .......at 7:30 A.M.
In response to the above referenced application for a policy of title insurance, the insurer hereby reports that it is prepared to
issue, as of the date hereof, a California Land Title Association Standard Coverage Form Policy of Title Insurance describing the
land and the estate or interest therein hereinafter set forth in Schedule A, insuring against loss which may be sustained by reason of
any defect, lien or encumbrance not shown or referred to as an Exception in Schedule B or not excluded from coverage pursuant to
the printed Schedules, Conditions and Stipulations of said policy form.
This report (and any supplements or amendments thereto) is issued solely for the purpose of facilitating the issuance of a policy
of title insurance and no liability is assumed hereby. If it is desired that liability be assumed prior to the issuance of, a policy of
title insurance, a Binder or Commitment should be requested.
....
LA
oco
C'r'TTr'rr1T r A
The estate or interest in the land described or referred to in this schedule covered by this report is:
AFEE
Title to said estate or interest at the date hereof is vested in: - - - -
TED COLDRC AND SANDRA LEE COLD3ERG,
1ilJSM0 AND WIFE AS JOINT TENA!ITS -
The land referred to in this report is situated in the State of California, County of 5M DIEGO
and is described as follows:
LOT 330 OF LA COSTA MEADOWS UNIT NO 2 4 1 11 TilE CITY OF CARLSBAO 4
COtThIY OF SAN OZECU, STATE OF CALIF0R3LA, ACCORDING TO MAP
TEEOF NO, 6905, FILED IN TE OFFICE OF TilE COUNTY RECORDER
OF SAM DIEGO, APRIL 2I 1971.
-' •,• ' ö'
SCHEDULE B
At the date hereof Exceptions to coverage in addition to the printed exceptions ' and exclusions contained in said policy
form would be as follows:
1. GENERAL AND SPECIAL COUNTY AND CITY TAXES
FOR THE FISCAL YEAR : 1983-194
INCLUDING PERSONAL PROPERTY TAX, IF MY,
FIRST INSTALLMENT : PAID
SECOND INSTALLMENT : OPEN
"TAX FOR -FISCAL YEAR 93-19$4
CODE AREA : 09064
PARCEL NO. : 215-340-32
LAND : $61,996
IPROVEMENTS ; NONE
PERSONAL : NONE
EXEMPTION : NONE
ANY OTHER EXE4P'TLONS : NONE
FIRST 1NSTAL1JENT : $34.14 PAID
SECOND INSTALLMENT : $3$4.14 OPEN
2. VIE LIEN OF SUPPLEMENTAL TAXES, IF ANY, ASSESSED PURSUANT
TO THE PROVISIONS OF CHAPTER 498, stAtirrEs OF 1913 OF ThE STATE OF
CALIFORNIA.tJ
3. COVENANTS, CONDITIONS AND RESTRICTIONS IN THE DEC1APTlON OF
RESTRICTIONS
RECORDED NAY 6, 1971 PS FILE NO,. 93263
RESTRICTIONS, IF ANY, BASED ON RACE, COLOR, FELIGION OR NATIONAL
ORIGIN' ARE DELETED,
VIIICTj PROVIDE TUAT A VIOLATION TREREOF SIALL NOT DEFEAT OR RENDER
INVALID ThE LIEN OF ANY ?QRTCACE OR DEED OF TRUST MADE IN COOl)
FAITH AND FOR VALUE,.
SAID COVENANTS, OONDITONS AND RESTRICTIONS HAVE BEEN
INCORPORATED BY REFERENCE THERETO IN A DEED
RECORDED : DECEIlSER. 20, 1971 AS FILE NO, 295088
4. AM AGREEMENT TO bMICH REFERENCE 1.5 HEREBY '4ADF. FOR FULL
PARTICULARS
DATED : JUNE 3, 1980
BY AND ET1EEN : TED COLOFEFO AND SANDRA LEE GOLORERO
AND THE CITY OF CARLSRAD
REGARDINC : AGREEMENT FOR TIRE PAYENT OF
A PM LX FACILITIES FEE
RECORDED : JUNE 16, 1Q30 AS FILE/PACE NO. 80-190532
REFERENCE IS MADE TO SAID DOCUMENT FOR FULL FARTICV1.ARS4b
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327,' — I CONDM 30 /LA COSTA VIEWIIL - I 328 / oocz-smi'd io c—.- 6/ 6o
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- , 312 .- 329 . / NOTE EACH SUB ID. INCLUDES 8 .55J
317
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325 / 3* Cc - — -
• .. El 313 '. •-.: . .. d 32 . I t COSTA. PAR I PM 10061
34 ç' / DOC8O 307157
• .• 30 / NOTE EACH SUB ID INCLUDES — — —
3l5 ' - 26 . •. / AN UND.INT IN COMMON AREA
. . 0 324
- . .: • . •. . . . . • . .(J •• . / CONOM: DOC. 78-50955 331
25
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16 3 / NOTE EACH SUB ID INCLUDES I -
- i' * 323 " / AN UND 4 INT IN
.s 2O.- . . - . 'PAR.A •.J.> o . / COMMON AREA
332 2 /
322,'(. •-/ I -.. . •• .. •• . .
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-333 NOTE EACH SUB ID INCLUDES AN UND 1/2 INT IN COMMON - -
- 23 1, / AREA WITHIN ITS RESPECTIVE PARCEL
•.•- ,-...-•.-.' .- . - 1 . . . . 32I / 5* CONOM
/ PARCEL A PM 10352 le this plat is believed
DOC8I-023I13 be correct, the company asu
- .. - .. - 30 'pc 334 <
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335
• .. - , I MAP I0I2 -CARLSBAD TCT NO 80-2(CONDM) -,
- - - / MAP 6905- LA COSTA MEADOWS UNIT NO .2 - LOTS 311-317 320-341
• :.. . L:.' -.. -:-.•.;. ... 362-366 & 399-401 --
SAN DIEGO COUNTY ASSESSOR'S NAP RE 215 PG 3 -aApI1tD R SES PP5ESI}ILf'.. ... . f. . •.. .. . .., - - . • . . • . . SHT. I OF Z - -.'-i-'---. :: • -: - - : .- ......................• . •
•-----.-. p ._._ ;-.s.-'--_-:-_-_.. __-- -_ . . .... - •_ - .. - .. . ... -
TITLE ORDER N0. ....13.7.I. .......
ESCROW ...............
AFTER RECORDING MAIL TO
kl...Y..AprJUt ..........................................
CA ?.P1 .......................................
IL €os
BOOK 1980
RECORDED REQUEST OE
WESTLAND TITLE CO.
JAN 288:00 AM'80
OFFICIAL RECORDS
SAN DIEGO COUNTY, CALIF.
VERA L LYLE
RECORDER
3.Oo
SPACE ABOVE FOR RECORDER'S USE ONLY
Grant Deed
A.P.N. 215 340 32
The undersigned grantor(s) declare(s):r TRANSFER TAX P4Pn
fAN DIEGO COUN1Y RCORDR Documentary transfer tax is $ 64.90
) computed on full value of property conveyed, or
computed on full value less value of liens and encumbrances remaining at time of sale.
Unincorporated area: (xx) City of Carlsbad , and
FOR A VALUABLE CONSIDERATION, receipt of which is hereby acknowledged.
RICHARD N. WITZ and MARTHA M. WITZ, husband and wife,
hereby GRANT(S) to
TED GOLDBERG and SANDRA LEE GOLDBERG, husband and wife, as Joint Tenants
the following described real property in the City of Carlsbad
County of San Diego ,State of California:
Lot 330 of LA COSTA MEADOWS UNIT NO. 2, in the City of Carlsbad, County
ol Sati Diego, State of California, according to Map thereof No. 6905
filed in the Office of the County Recorder of San Diego, April 21, 1971
Dated December 3, 1979 ~4L~ M A~
Richard N Witz
- ,, - ,-- I_ 'v
Martha N. Witz STATE OF CALIFORNIA
COUNTY OF San fliegn
On_Derember 14, 1979 before me, the under-
signed, a Notary Public in and for said County and State, personally
appeared _Richard M. Witz—and Martha M. Witz
- , known to me
to be the person &.whose name_S aresubscred to the within
instrument icknowl dg d that\ thy V.eiecuted the same.
Linda L. Thornton
Name (Typed or Printed)
Notary Public in and for said County and State
MAIL TAX
STATEMENTS TO same as above
Name - - - Street
FORM 4090, 7/77
City State Zip
E
L00. 37
" 10 00-
SAN ML4RCt3 UNIFIED SCHOOL DISTRICT
PROJECT SERVICE AVAILABILITY LEER
—.--. \ t_•
ppiicant i. ii. in - ieg.Lu.Ly)
APPLICANT:
\-'\' Phone No
Address:
OWNER: Phone No._____________________
Address:
DESCRIPTION Project Address/Location\ \'Qj t)_tS
Name: I
'oject located on
Assessor's Parcel No.(s):
Attach legal description
if necessary)
Tract No.
(check one or more)
Se Minor Subdivision (TPM)
IT Major Subdivision (TM)
Assessor's Parcel Numbers __ ____
l.krEE% 3H II_II
2.1 __I _IiIi .
HousingType No. ofD.U.'s No. ofBedrooms
Single Family
Multiple Family
Mobilehome Units
1. Owner/applicant agrees to reconfirm this project with the issuing school district every 6 months
unless such action is not required by the district. District Phone619-744-4776
2. Owner/applicant understand that the certification for school service contained in this Project
ServiceAvailabilityLetter is no longer effective if the project is disapproved or if the con-
ditional project approval (subdivision, permit, or other conditional use processes) expires.
3. The information I have provide is coitct.
APPLICANT's SI(FATURE Date _\\\ \
SAN MARtXS UNIFIED-SCHOOL DISTR.ICI'
CERTIFICATION OFSCH(DL AVAILABILITY ORNON-AVAILABILITY
Date: ?) F" DAY Frf—Pt YR
It): City of Carlsbad
FROM: School District San _Marcos _UNIFIED Grades Served: K-i2
1. Z School services and facilities are committed for this project. Services will be available
concurrent with project need based on a secured agreement with the developer which has
adequate financing and clear intent. The termination date of the document is:
See attached copy.
2. r The undersigned school district hereby certifies that it will be able to provide adequate
school services and facilities to the above described project concurrently with the need of
such project. Owner/applicant has paid the required developers fee.
3. 71 The undersigned school district hereby certifies that it will not be able to provide adequate
school services and facilities to the above described project concurrently with the need of
such project because
DISMICr REPRESENTATIVE'S SI 4 .—Date January 12 1984
TITLE Facilities Tech Phone 7444776
- rnr ,,- "m CV' '.1 r77 TITt't) I AT)DT Tr'A?,yP
.
• 4/17/8
Y- -\\•
LEUCADIA COUNTY WATER DISTRICT
APPLICATION FOR SEWER SERVICE
Owner's Name - Ted Goldberg No. 481-6944
Mailing Address 2311 Via Aprilia
WER PERMIT ISSUED UPON
Del Mar, CA 92014 CEIPT OF BUILDING PERMIT. Service Address: £ BUILDING PERMIT MUST BE Tract Description: -Lot 330 ]a Costa Meadows #2 APPLIED FOR BY Assessor's Parcel No. 215-340-32
Type of Building Dup1x No. Units 2 Connection Fee $i,2inp
Lateral Size: 4" - 6" - 8" Saddle Easement Connection - pre-pd (400.00)
Extra Footage: @ $________ Extra Depth: - @ $
Lateral Fee
Amount Rec'd Prorated Sewer
Service Fee Ck. No/Cash
Date
Rec 'd By .• Total
The application must be signed by the owner (or his authorized representative) of
the property to be served. The total charges must be paid to the District at the
time the application is submitted.
If a service lateral is required, it will be installed by the Leucadia County Water
District. The service lateral is that part of the sewer system that extends from
the main collection line in the street (or easement) to the point in the street (at
or near the applicant's property line) where the service lateral is connected to
the applicant's building sewer, The applicant is responsible for the construction,
at the applicant's expense, of the sewer pipeline (building sewer) from the appli-
cant's plumbing to the point in the street (or easement) where a connection is made
to the service lateral.
The connection of the applicant's building sewer to the service lateral shall be
made by the applicant at his expense. The connection must be made in conformity
with the District's specifications, rules and regulations; and IT MUST BE INSPECTED
AND APPROVED BY THE DISTRICT BEFORE THE SEWER SYSTEM MAY BE USED BY THE APPLICANT.
THE APPLICANT, OR HIS AUTHORIZED REPRESENTATIVE, MUST NOTIFY THE DISTRICT AT THE
TIME INSPECTION IS DESIRED. ANY CONNECTION MADE TO THE SERVICE LATERAL OR COLLEC-
TION LINE WITHOUT PRIOR APPROVAL AND INSPECTION BY THE DISTRICT WILL BE CONSIDERE
INVALID AND WILL NOT BE ACKNOWLEDGED.
The prorated sewer service fee is based upon the date the District estimates that
service will begin and covers the balance of the fiscal year. There will be no
additional fee or refund if service actually commences on a different date. For
succeeding fiscal years, the sewer service fee will be collected on the tax roll
in the same manner as property taxes.
The undersigned hereby agrees that the above information given is correct and agrees
to the conditions as stated.
____________ 90p,
Owner's Sig ture Date Account No:
QUALITY
ORIGINAL (S)
CITY OF CARL AD
1200 ELM AVENUE • CARLSBAD, CALIFORNIA 92008
(714) 438-5551
RECEIVED FROM \ DATE
a fin = CC C
A/C. NO. DESCRIPTION AMOUNT
L -
22
TOTAL 35 9 77 7 --T1 —