HomeMy WebLinkAboutPR 4.44; JOHNSON RETAINING WALL; Engineering Application317 I
• CITY OF CARLSBAD • .., ENGINEERING DEPARTMENT -ABOVE GROUND ENCROACHMENT PERMIT APPLICATION
PERMIT NO. j?R 4. 4-4 I PROJECT NAME j 0Dhn soV\ J<_.,__~ Will
LOCATION OF PROJECT: ON THE I GJes+-jsmE OF' Do,iJJ\J.4 [)(2-
(NORTH, SOUTH, EAST, WEST) (NAME OF STREET)
BETWEEN I 0 ~ :s W ¥ AND .__le._e. __ C:_:t_. _______ ___,
(NAME OF STREET) (NAME OF STREET)
ASS_ESSOR PARCEL NO(S). j..---2-0_5'. ___ 15_2.. ___ 1...,..\--------------------.
BRTEF DESCRIPTION OF ENCROACHMENT: 'RetA:,vu~ JA \ \ to' I Hiah ~
I I ea oF brow ~ ch..
REASON FOR ENCROACHMENT: I IO
OWNER APPLICANT
NAME (PRINT OR TYPE) NAME (PRINT OR TYPE)
,__ ,._, ,0 .3 oh i.iJ~ oi.J . e.;e 1 , . ~1;> \ ,'\II
MAILING ADDRESS MAILING ADDRESS
3 1-/?/ '/.)o,,)I\Jf:i De. 3;;;7 V1.s-l.~ ,4/e (<-1A·
CITY AND STATE ZIP TELEPHONE CITY AND STATE ZIP TELEPHONE
l'.1°'r\.s~ C.f\ 92005 -32.43 D~e:-. '1;1c.ie. Ci\-()?os7 t/371,57. .
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT I CERTIFY THAT I AM THE OWNER'S REPRE-ALL THE ABOVE INFORMATION IS TRUE AND CORRECT SENTATIVE AND.THAT ALL THE ABOVE TO THE BEST OF MY KNOWLEDGE. INFORMATION IS TRUE AND CORRECT TO SIGNATURE DATE THE BEST OF MY KNOWLEDGE. SIGNATURE , DATE di
A./i'~ 1f2. n I. ·,~. __. -· r,,1
**************************************************************************************
FOR CITY USE ONLY
TOTAL FEE REQURIEDj,...,,1J'"""'5_{) __ 0_0 __ ....,
DATE FEE PAID' 4-24-'1/ CITY OF CARLSBAD
RECEIPT NO. I 3£pzo
RECEIVED BY:
Q_W~
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