HomeMy WebLinkAboutPR 4.56; SCHLEE RESIDENCE; Engineering Application-CITY OF·CARLSBAO A ENGINEERING DEPARTMENT W ABOVE GROUND ENCROACHMENT PERMIT APPLICATION
PERMIT Na.1 ?R. +-slo I PROJECT NAME/. s(!-l ,If£ · e"°· ~ g C) >4'1hni l'!i>
LOCATtoN oF PROJECT: ON THE I G'..A.S-T jsroE oF,_I ____ ..... Pr ....... V ....... J.:ao:.L.1-.A...__ ____ _
(NORTH, SOUTH, EAST, WEST) (NAME OF STREET)
BETWEEN .·j N~E, L\ JV-A I AND I CD 6i!. !) 0 B f:s
(NAME oF STREET) 4qz.:s Av, 114 A O e (NAME oF STREET)
ASSESSOR PARCEL NO(S). I .2 t> 7-_360 -z. J
BRIEF DESCRIPTION oF ENCROACHMENT: lJ A I J +0 ke£ +,e<t> 7VJ .
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REASON FOR ENCROACHMENT: GX.L S
OWNER APPLICANT
NAME. ( PRINT OR TYPE) NAME (PRINT OR TYPE)
MAILING ADDREssLJ '1 ~ Aoi/,1 Av .MAILI_NG ADD~Ess 6JJJJ1£..
I CtRTIFY THAT I AM THE LEGAL OWNER ANO THAT. I CERTIFY THAT I AM THE OWNER'S REPRE-· ALL THE ABOVE INFORMATION IS TRUE ANO CORRECT SENTATIVE AND THAT ALL THE ABOVE TO THE BEST OF HY KNOWLEDGE. INFORMATION IS TRUE AND CORRECT TO S~GNAT DATE THE BEST OF HY KNOWLEDGE.
FOR CITY USE ONLY .
TOTAL FEE REQURI EDI,... ,-o-D ___ o_P ___ __,,
DATE FEE PAID! 4 -J ... 9 2.
RECEIPT NO. , · \ I J 1-4:
RECEIVED BY:
SIGNATURE DATE
APR O 11992
CITY OF CARLSIAD ·
OATE sffl~1iffl~ffio<fi'Wffiffi
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