HomeMy WebLinkAboutPD 06-05; SIMPSON RESIDENCE; Engineering Application,-:--,'c
PROJECT ADDRESS:~J.Ji:.:.4-J,o:z.:.~J..IUIIU;..~:;...a,...1.,;,L.,::...~;..:.:.J~"----------:------
LOT NO(S).: _____ MAP NO.: _____ APN(S).: llP1--·I LP0--14:, I ?J
NUMBER OF LOTS: NUMBER OF ACRES:
OWNER: APPUCANT:
Mailing Address: Mailing Address:
CAtlhbNl. CA. g?1[(Jb I
Phone Number:
Fax Number:
E-Mail:
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:
CIVIL ENGINEER~. ~1,,. FIRM: :fYle1' ~
Mailing Address: =
Cut tl#Ad I CA vf II
Pbone Number: '7(p9rm· f)'Q~
Fax Number: 1 l.DO fl vl~ I -11_ >
E-Mail:
State Registration Number:
~ADDmONAL COMMENTS:
Phone Number:
Fax Number:
E-Mail:
Signature:
· Phone Number:
Fax Number:
E-Mail:
State Registration Number:
. _ .... _______ IMPROVEMENT VALUATION
1; What water district is the proposed project located in? (check one)
Date:
Ocarlsbad Municipal _Water District Oonvenhain . Ovallecitos
2. !fin 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 QUANTITIES
remedial ___ cy import ___ cy export cy =,:f::
"----------------S-EE_R_E_V_E-RS .... E_S_I_DE ___________ tol_o-0)--d \~
H:/OEVELOPMENT SERVICES/MASTERS/AppUcation for Enginaaring Plan Check miv~w·,, ,_ .,_
cut ___ cy fill ___ cy
--ciTY OF CARLSBAD -ENGINEERING DEPARTMENT
APPUCATION FOR GRADING PERMIT
PERMIT NUMBER:
PROJECT NAME: k'ets&Y=: #ottvl'tlk 1-dw PROJECT NUMBER:
PROJECT LOCATION; 2(CfJ 9ff>tld/lJ ,41 ?#_f5C,fm(,. t'k A DRAWING NUMBER:
ASSESSOR PARCEL NUMBE~\S):
PROJECT DESCRIPTION: (t,<.;
141-If()--!4 ;q '-t (
OWNER:
ADDRESS:
CITY: ...,Ct,u...~.:......::.=.S......_fi,..4--(2..,.___.'--_________ sTATE: t:A
FAX NUMBER:
SUITE:
ZIP: 9zepe,
PHONE NUMBER: --------------------------------
I CERTIFY THAT I AM THE LEGAL OWNER OF THIS PROPERTY AND I AUTHORIZE THE GRADING ASSOCIATED
WITH THIS PERMIT.
OWNER SIGNATURE: DATE: 5 /2/4,
CML ENGINEER;
ADDRESS: /' ~ C) SUITE:
CITY: (">&?4:v,W
PHQNE NUMBER: ~60 -ezz -1$!3(/8
STATE: {!-t4 ZIP: t'J,Z.t> //
FAXNUMBER: °/~-'7,5/-778D
. SOILS ENGINEER:
ADDRESS: ·?J.'2.0 Te.4-PE: c)T}U;t=-L
CITY: ~i2J 751 e?bO . . . STATE: <16:-ZIP:
SUITE:
9:Z t 2(
PHONE NUMBER; 6~ 5"4'1 ,.. 12:Z 'l,, FAXNUMBER: 6$ §4q-(Go1
GRADING CONTRACTOR: ______________ STATE LICENSE NO.:
CITY BUSINESS UCENSE NO.
ADDRESS: ----------------------------SUITE:
CITY: STATE: ZIP: --------------------------
PHONE NUMBER: FAX NUMBER: -------------------------------
GRADING QUANTITIES: cut ___ O/ fill 0/ import ___ Of
remedial 0/ export ___ 0/
QUALIFIED CONTACT PERSON TRAINED IN NPDES REQl,JIREMENTS: _________________ _
PHONE NUMBER:
BASIS OF PERMIT FEES:
VERIFIED BY:
---------cy TOTAL ·PERMIT FEES:
BALANCE DUE:
$
$
I hereby a<:knowledge that I have read the application and information provided is correct. I agree to comply with
all federal, state, and city laws, ordinances, regulc:1tions and policies relating to excavation and grading including, but not
limited to, the Federal 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
ADDRESS:
this application. / r' . . I
APPUCANTNAME: lLCVI) d/1tl/?S07V ptos= ~1&1/fi 'l>&tt/[· . suITE:
--,.::.{.-L..J.~-=l=J.~~~=----r~f'T-1!'-,.--STATE: &I. ZIP: f1-t!cCJi
PHONE NUMBER: D '-f'.: 1/-$a ~ FAX NUMBER: 76t' L) ?{ -?780 .
t . DATE: 5/z/tJb
~l
CITY:
Ii /DEVELOPMENT SERVICESIMASTERSIApphca11on for Grading Perrnil