HomeMy WebLinkAboutMS 04-06; MAY MINOR SUBDIVISION 3RD EXTENSION - AKA HUMPHREY RESIDENCE; Minor Subdivision (MS)^ity of
Carlsted
LAND USE REVIEW
APPLICATION
P-1
Development Services
Planning Division
1635 Faraday Avenue
(760) 602-4610
www carlsbadca gov
APPUCATIONS APPLIED FOR. (CHECK BOXES)
Dmelooment Permits
I I Coastal Devetopment Pemlt C] Minor
□ CondlUonalUse Permit
n Minor n Extension
r~l Day Care (Large)
I~1 Environmental Impact Assessment
n Habitat Management Permit [U Mmor
l~l HlSslde Development Permit D Minor
r~l Nonconfbrming Construction F^rmK
n Planned Development Permit C] Mirxsr
I I Reeidential [ZI Non-ftesidontial
l~l Planning Commission Determination
l~l Reasonable Accommodataon
r~l Sate Development FMan [J Mmor
Tentative Parcel Map (Minor Subdivision)
r~l Tentative Tract Map (Major Subdmslon)
I~1 Variance [U Minor
(FOR DEPT USE ONLY) Legislative Permits (FOR DEPT USE ONLY)
m 0^-0^
□ Qeneral Plan Amendment
Q Local Coastal Program Amendment
I~1 Master Plan CU Amendment
n Specific Plan [~l Amendment
O 2tono Change
f~l Zone Code Amendment
§oi!QL£sdsbBi^a3MBsxim£m
Permits
n Review Permit
n Administrative CH Mmor dl Major
Wfeae Review Area Permits
I~1 Review F'ermit
d] Admmistratwe dl Minor dl Major
MOTE APHOPOSEDPROJECTREQUmmOAPPLlCAIlONaifflMnTALHUaTBESUBWTTEDBYAPPOINTMENr. PLEASE CONTACT THE APPOWTMENTSPKaAUSTAT (7S0) fflZ^CrU TO SCfSDULE AN APPOIfrniffiNT •SAME DAY APPOtNTMENTS ARE NOT AVAILABLE
ASSESSOR PARCEL NO(S)
LOCATION OF PROJECT
NAME OF PROJECT
BRIEF DESCRIPTION OF
PROJECT
/(?7- 0^0- ^p.) ri\fA\hn . rurifgl/inW.
(STREET ADDRESS)Mgry MayMinor 5uK - A ^N\Fs, CifciaLgi
PROJECT VALUE
(SITE IMPROVEMENTS)ESTIMATED COMPLETION DATE
FOR CITY USE ONLY
Development No
P-1
■Y ,
Lead Case No
Page 1 of 6 Revised 03/17
OWNER NAME (PLEASE PRINT)APPUCANT NAME (PLEASE PRINT)
INDIVIDUAL NAME
(ifappiteable)
COMPANY NAME
(If applcable)
MAJUNG ADDRESS
CITY, STATE, ZIP
TELEPHONE
EMAIL ADDRESS
INDIVIDUAL NAME
(Kappllcabte)
COMPANY NAME
(If ^jpDcabte)
SllLA)a7>4A?l|aMU''° address
CrTY, STATE, ZIP
TELEPHONE
hciry 1^0.^
Oc^(xr^<^\Xp CA
marij fAOAj LADDRESS
/n
ICERTII
INFOI
AT I AM THE LEGAL REPRESENTATIVE OF THE OWNER
. THE ABOVE INFORMATION IS TRUg AND CORRECT TO
'KNOWLEDGE
T I AM THE LEGAL OWNER AND THAT ALL THE ABOVE
IS TRUE AND CORRECT TO THE BEST OF MYN
ICERTFY/AS LEGAL OWNER THAT THE APPUCANT AS
HEREIN ISJmY AUTHORIZED REPRESaiTATIVE
I CERTIFY
AND
iuEUs:
SIGNATURE"8IGNATU
ENTATT 'EAPPUCANTSREP
MAIUNG ADDRESS
CITY, STATE, ZIP
TELEPHONE
EMAIL ADDRESS
I CERTIFY THAT I AM THE REPRESENTATIVE OF THE APPLICANT FOR
PURPOSES OF THIS APPUCATION AND THAT ALL THE ABOVE
INFORMATION IS TRUE AND CORRHTT TO THE BEST OF MY
KNOWLEDGE
SIGNATURE DATE
IN THE PROCESS OF REVIEWING THIS APPUCATION IT MAY BE NECESSARY FOR MEMBERS OF CITY STAFF, PLANNING
COMMISSIONERS OR CITY COUNCIL MEMBERS TO INSPECT AND ENTER THE PROPERTY THAT IS THE SUBJECT OF THIS
APPUCATION lAVE CONSENT TO ENTRY FOR THIS PURPOSE
NOTICE 01
RECORDER
;land
JCTTON PROPERTY OWNER ACKNOWLEDGES AND CONSENTS TO A NOTICE OF FlESTRICmON BEING
IE TriLE TO HIS PROPERTY IF CONDITIONED FOR THE APPLICANT NOTICE OF RESTRICTIONS RUN WITH
lIND ANY SadcfesSORS IN INTEREST
FOR CrKY US
received
APR 1 8 2018
CITY OF CARLSBAD
i^fefelVED
RECEIVED BY
P-1 Page 2 of 6 Revtaed 03/17
itvof
Development Services
Planning Division
1635 Faraday Avenue
(760) 602-4610
www carisbadca gov
Applicant's statement or disdcsure of certain ownership interests on all applications which will
require discretionary action on the part of the City Council or any appointed Board, Commission
or Committee
The following information MUST be disclosed at the time of application submittal Your project
cannot be nevieyved until this information is completed Please pnnt
Note:
Pereon is defined as "Any individual, firm, co-partnership, joirjt venture, association, social club, fraternal
organization, corporation, estate, trust, receiver, syndicate, in this and any other county, city and cpunty,
city muniapality, district or other politckl sufcidjvision or any other group or combination acting as a unit
Agents may sign this document, however, the legal name and entity of the applicant and property owner
must b? provided below
1 APPLICANT (Not the applicant's agent)
Provide the COMPLETE. LEGAL names and addresses of ALL persons having a
financial interest in the application If the applicant includes a corporafaon or partnership,
include the names, titles, addresses of all individuals owning more than 10% of the
shares IF NO INDIVIDUALS OWN MORE THAN 10% OF THE SHARES, PLEASE
INDICATE. NON-APPLICABLE (N/A) IN .THE .SPACE .BELOW, If a publiclv-owned
corporation, include the names, titles, and addresses of the corporate officers (A
separate page may be^ttached if necessary) .
IAoKTU Corp/Part ^ I C\ /Ni
X Title i (_
Person
Title.
Corp/Part_
Title
7^
3S/7 E|
OWNER (Not the owners
Provide the COMPLETE.
■ddress
sboc:
LEGAL names and addresses of ALL persons having any
ownership interest in the property involved Also, provide the nature of the legal
ownership (i e, partnership, tenants in common, non-profit, corporation, etc) If the
ownership includes a corporation or partnership, include the names, titles, addresses of
all individuals owning more than 10% of the shares IF NO INDIVIDUALS OWN MORE
THAN 10% OF THE SHARES, PLEASE INDICATE NON-APPUCABLE (N/A) IN THE
SPACE BELOW If a publiclv-owned corporation, include the names, titles, and
addresses ef the corporate officers (A separate page may be attached if necessary)address^ pt tne corporate onic
Corp/Part_
Title
PersonTitle 0\A)nfr . ^
Address.Oc<2img.\
P-1(A)Page 1 of 2 Revised 07/t0
NON-PROFIT ORGANIZATION OR TRUST
if any person identified pursuant to (1) or (2) above is a nonproftt organization or a trust,
list the names and addresses of ANY person serving as an officer or director of the non
profit organization or as trustee or beneficiary of the
Non Profit/Tru8t_
Title
Non Profit/Trust
Title
Address Address
Have you had more than $500 worth of business transacted with any member of City
staff, Boards, Commissions, Committees and/or Counal within the past twelve (12)
months'?
I I Yes |\/^No if yes, please indicate person(s).
NOTE: Attach additional sheets if necessary
he above information is true and correct to the best of my knowledge
liii^
that a
Pnnt or type name/Of
Signature of applicant/date
Pnnt or type name of applicant
Signature of owner/applicant's agent if applicable/date
Pnnt or type name of owner/applicanfs agent
P-1(A)Page 2 of 2 Rewsed 07/10