HomeMy WebLinkAboutEIA 05-04; WORSCH RESIDENCE; Environmental Impact Assessment (EIA)• Attn lien flflIIflAI -nfl •fla -r.n.t
CITY OF CARLSBAD
1)
(FOR
DEPARTMENT
[II] Administrative Permit
[II] Administrative Variance
[I] Coastal Development Permit
El] Conditional Use Permit
LII] Condominium Permit
NZA Environmental Impact Assessment
[I] General Plan Amendment
Hillside Development Permit
[III] Local Coastal Program Amendment
Master Plan
LIII Non-Residential Planned Development
El Planned Development Permit
2) ASSESSOR PARCEL NO(S).: ii-oso-s
3) PROJECT NAME: Worsch Residence
4) BRIEF DESCRIPTION OF PROJECT:
(FOR
DEPARTMENT
El Planned Industrial Permit
El Planning Commission Determination
El Precise Development Plan
El Redevelopment Permit
El Site Development Plan
El Special Use Permit
El Specific Plan
El Tentative Parocl Map
Obtain from Engineering Department
El Tentative Tract Map
El Variance
[III] Zone Change
LINJ List other applications not specified
5) OWNER NAME (Print or Type) 6) APPLICANT NAME (Print or Type)
Christina Worsch Ted Olsen
MAILING ADDRESS MAILING ADDRESS
45869 Meadow Lake Or
4940TdS 5J
CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE
Indio Ca 92201 San Diego CA 92115 619-793-6728
EMAIL ADDRESS: EMAIL ADDRESS:
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE I CERTIFY THAT I AM THE LEGAL REPRESENTATIVE OF THE
INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
KNOWLEDGE. CORRECTTO THE BEST OF MY KNOWLEDGE.
SIGNATURE DATE SIGNATURE DATE
7) BRIEF LEGAL DESCRIPTION
NOTE: A PROPOSED PROJECT REQUIRING MULTIPLE APPUCATIONS BE FILED, MUST BE SUBMITTED PRIOR TO 3:30 P.M.
A PROPOSED PROJECT REQUIRING ONLY ONE APPLICATION BE FILED, MUST BE SUBMITTED PRIOR TO 4:00 P.M.
Form 14 Rev. 12104 OF
is
8) LOCATION OF PROJECT: El Caimno Real
ON THE I I SIDEOFI I
(NORTH. SOUTH. EAST, WEST) (NAME OF STREET)
BETWEENI I ANDj I (NAME OF STREET) (NAME OF STREET)
9) LOCAL FACILITIES MANAGEMENT ZONE I
10) PROPOSED NUMBER OF LOTS 11) NUMBER OF EXISTING
RESIDENTIAL UNITS
12) PROPOSED NUMBER
OF RESIDENTIAL UNITS
13) TYPE OF SUBDIVISION 14) PROPOSED IND OFFICE!
SQUARE FOOTAGE
15)
I
PROPOSED COMM
SQUARE FOOTAGE
16) PERCENTAGE OF PROPOSED 17)
PROJECT IN OPEN SPACE
PROPOSED INCREASE
IN ADT
18) PROPOSED SEWER
USAGE IN EDU
19) GROSS SITE ACREAGE j20) EXISTING GENERAL
PLAN
21)
'
PROPOSED GENERAL
PLAN DESIGNATION
22) EXISTING ZONING e 3) PROPOSED ZONING 24) HABITAT IMPACTS
IF YES, ASSIGN HMP# N
25) IN THE PROCESS OF REVIEWING THIS APPLICATION IT MAY BE NECESSARY FOR MEMBERS OF CITY
STAFF, PLANNING COMMISSIONERS, DESIGN REVIEW BOARD MEMBERS OR CITY COUNCIL MEMBERS
TO INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS APPLICATION. I/WE CONSENT
TO ENTRY FOR THIS PURPOSE
SIGNATURE
FOR CITY USE ONLY
FEE COMPUTATION
RECEIVED
APPLICATION TYPE FEE REQUIRED
TOTAL FEE REQUIRED
OCI 1 235
CITY OF CARLSBAD
PLANNING DEPT
DATE STAMP APPLICATION RECEIVED
RECEIVED BY:
eeuLL ,c141
Form 14 Rev. 12104 PAGE 2 OF 5