HomeMy WebLinkAboutPR 3.4.266; CZAJKOWSKI PROPERTY; Engineering ApplicationCITY OFARLSBAD - ENGINEERING•PARTMENT
APPLICATION
FOR ENGINEERING PLANCHECK OR PROCESSING
Complete all appropriate information. Write N/A when not applicable.
OLA)SI't - - - -------U
PROJECT NAME: DATE:5/9/u gQIC
PROJECT DESCRIPTION: .,,ve /4Y .c477OA
PROJECT ADDRESS:
LOT NO(S).: _ ø 4 9, /0 MAP NO.:5524 APN(S).: 95. C?, /0
OWNER: A'cqr _ APPLICANT: _ . Aar,_4'
Mailing Address:' *o s./ Mailing Address: 05IST
S .v D'____tA_12/ _ (1aoY
-/
Phone Number: (_CI'?)_1/S'2__-j/( 7 Phone Number: (_4'2 5//7
certify that I am the legal owner and that all the above information
is true and correct to the l2est ofmy k owle .
Signature __ Date
I certify that I- am the agent of the legal owner and that all information on
this sheet is true and correct to the best of y knowledge.
Signature _Date___________
CIVIL ENGINEER: _ r iL SOILS ENGINEER: A114
Firm: Firm:
Mailing Address: - Mailing Address:
Phone-Number: ( Phone Number
State Registration Number: State egistratiOn Number:
LANDSCAPE ARCHITECT: j Ii'? ADDITIONAL COMMENTS:_____________________
Firm:
Mailing Address: -
Phone Number: ( --- - _
State Registration Number:
NO. OF DWELLING UNITS: ZONE:. OF LOTS:_ NO. OF ACRES:_____
IMPROVEMENT VALUATION: sewer, water & reclaimed water: _it//A
Water District (circle one) :palWateitrict Olivenhain Vàllecitos
streets and drainage:
GRADING QUANTITIES:,(/4 Cy cut Cy fill - cy
-- remedial cy import/export cy -
PLEASE CHECK OFF APPLICATION TYPES ON REVERSE SIDE
REV 04/28/95 P:\DOCS\MISFORMS\FRM00063
• FOR cP/USE ONLY
Plancheck Type Drawing, Project 'Deposit/Few APPLICATION FOR
(CHECK ALL THAT APPLY): Number NUmber ID. Paid
Plat
—
[]Adjustment ADJP
O Certificate of compliance OC
' 0O 00 edication of Easement
Type: ST1EET7-
Type:
O Encroachment Permit ENCROAC1-$
O Engineering Standards Variance ESV
0 Final Map .. .
FM
rading Plañcheck -
- GRPC
0 Grading GRADING
O Improvement Plancheck . '
0Landscape Plancheck LPC
O Parcel Map .
. PM.
O Quitclaim of Easement .
. . QUITO
.
Type: . .
Tye:
0 Reversion to Acreage . . .
RTA
. .
.
OStreet Vacation
o Tentative Parcel Map
o Certificate of Correction .
CcCR :
DCove nant for Easement -: COVE .
: ..
0 Substantial Conformance Exhibit
APPLICATION ACCEPTED BY
MASTER PROJECT ID________________________ REC!EVED RECEIPT NUMBER
PREL!MINARYSIERRA$VSTEM INPUT INITIAL.;- . . 16 SIERRA:.$YSTEM INPUT INITIAL..... . . . . -
R BASE INPUT INITIAL______________
RL MASTER FILE NUMBER F
DATE STAMP
APPLICATION RECEIVED
P:\DCCS\MiSF0RMS\0RM00063 - REV-04/28195