HomeMy WebLinkAboutPD 02-01; STANCZAK RESIDENCE; Engineering Applicationfr "A LSEAD, iN to
APPLICATION
GRADING PERMIT
PERMIT NUMBER
PROJECT NAME: STArk 2ML PROJECT NUMBER: PD - O.- 21
PROJECT LOCATION: LC) T AWIØ) 1YZ. DRAWING NUMBER: -
ASSESSOR PARCEL NUMBER(S): 215-.G II 1.
PROJECT DESCRIPTION: FRW 91N&iE A1)1 JL'( E5L7A6
OWNER: M12 WAYNE
ADDRESS: 7'1I L I9LL)A) PLI9E SUITE:
CITY: C,P...LSFPD, 4. STATE: cz:A ZIP: 92cO'?'
PHONE NUMBER: (7') '131 1 FAXNUMBERT 74
I CERTIFY THAT I AM THE LEGAL OWNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT.
OWNER SIGNATURE: DATE:__________
CIVIL ENGINEER:
ADDRESS: SUITE:
CITY: STATE: ZIP:
PHONE NUMBER: FAX NUMBER:
SOILS ENGINEER: V!NJE 4 M!PPLTOA1
ADDRESS: 245 VI/'ff3P—D 4t' SUITE:
CITY: t ,CCIt.P1 Pe> I C14 i22J6TATE: _ZIP:________
PHONE NUMBER: C 7(') 743 1244. FAX NUMBER: (7k) 79 34 35-1
GRADING CONTRACTOR: STATE LICENSE NO.:
ADDRESS: SUITE:
CITY: STATE: ZIP:
PHONE NUMBER: - FAX--NUMBER:-_--
GRADING QUANTITIES: cut 4' fill q' import 4'
remedial _______ 4' export 4'
BASIS OF PERMIT FEES: cy TOTAL PERMIT FEES: $______________
VERIFIED BY: - BALANCE DUE:
I hereby acknowledge that I have read the application and information provided is correct. I agree to comply with all federal, state, and
city laws, ordinances, regulations and policies relating to excavation and grading including, but not limited to, the Federai Endangered
Species Act of 1973 and any amendments thereto. I will also comply with OSHA Permit-requirements for trenches over five feet deep
and the provisions and conditions of any permit issued pursuant to this application.
APPLICANT NAME: ¼AFS ç \ (
ADDRESS: P, 1 CS'4r'J \C(_ SUITE:
Cm': STATE: zIP: 92Y09
PHONE NUMBER: 760 ' 7O 3 FAX BER: 76'O j 7 ff '
APPLICANT'S SIGNATURE: C DATE: _________
f,.. linn Dn,,a Revised 1/14/02
• CITY OF CARLSBAD - ENGINEERING bEPiMENT'
APPLICATION
FOR ENGINEERING PLAN, CHECK OR PROCESSING
Complete all :appropriate information. Write NIA when not applicable.
PROJECT NAME LOT 2T70 4"J I AR DATE j,&r /Iofr2oD2
PROJECT DESCRIPTION'INJ L M\ L/ '(.,RAjr) 6 •Pt-AtJ
PROJECT ADDRESS 4\l I AP OP £Al2LS SAD, cA
LOTNO(S): MAP NO.: V2-42. APN(S):' •T!H°
NO. OF DWELLING UNITS: I LFMP ZONE: # LOTS: #ACRES:
OWNER: APPLICANT:.I
Mailing Address: /7 Mailing Address:; I -
Phone Number: (, ) - Phone Number: ( )
I certify that I am the legal owner and that all the above
information is true and correct to the best of my knowledge
Signature Date Signature Date
CIVIL ENGINEER: Atl— S . SVJE IS , SOILS ENGINEER:
Firm: '\'4S EQ(3RIN3S Firm: \1lNJ 4 PL-ETO? E-NG.
MailinAddress: "73 Oi r3StD CErflP -T. Mailing Address: 4V' #102-
SOO 31kN OLCAi2 ' '9JD0 CA -OZ
Phone Number: (P).) 2JIØ E5 5 (DS ' PhoneNumber: '74 (4
State Registration Number: ' State Registration -Number: '
AQDmbNAL COMMENTS:
IMPROVEMENT VALUATION '
1. 'What water district is the proposed project located in? (circle one) '
Carlsbad Municipal Water District ' Olivenhain ' Vallecitos
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 (if applicable)? '' $
3. What is the total' cost estimate, including the 15 6/o contingency fee, for sewer (fOr , Carlsbad
Municipal Water District only), street, public (median)landscape and irrigation,' and
drainage improvements (if applicable)? ' ' $
4. What is the total cost of landscape and irrigation improvements On private property (if applicable)? $
RA-DIN QUANTITIES
cut ()D cy flIl (oOQ cy ' remedIal ' cy h-nport/eport OO cy
H:WORS/DOCS/MISFORMS/APPLICATION ENG PLANCHECK OR PROCESSING :' ' : REV. 10/05/99