HomeMy WebLinkAboutPR 4.59; WIELAND RESIDENCE; Engineering Application• CITY OF CARLSBAD A ~ ENGINEERING DEPARTMENT 9 . ABOVE GROUND ENCROACHMENT PERMIT APPLICATION
. PERMIT NO-[jL'f:.fl'. PROJECT NAMEj Wi~ G;,at S,t:y,1ve Ro{)•
LOCATibN-o(PROJECT: ON THE I SoU'Jlf lsIDE oF/. 11!-{J~-_ A--0L,
(NORTH, SOUTH, EAST,, WEST) . (NAME OF _STREET)
BETWEEN, I SK-7LtAI€.. ~ I AND I j/t,z._'-7. 8/Ur~ L-/4-vE, 1
(NAME OF STREET). (NAME OF STREET)
ASSESSOR PARCEL NO( S}. ,r--;}_0_'7_.-_0_6_3 ___ . -_-/2_'fi __ ......,...0-6---~------
BRI EF DESCRIPTION OF ENCROACHMENT: c?:, lf 11
OWNER APPLICANT
NAME (PRINT OR TYPE)
€-
MA I L}_NG AODR.ES,S -~· ... _ _ _ .--. ___ _
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MAILING ADDRESS
CITY AND STATE . &4-fJ ZIP · TELEPHONE CITY ANO STATE
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ZIP TELEPHONE_
. I CERTIFY THAT I AM THE LEGAL OWNER ANO THAT I CERTIFY THAT I AM THE OWNER'S REPRE-ALL THE. ABOVE INFORMATION IS TRUE AND CORRECT SENTATIVE ANO THAT ALL THE ABOVE TO THE BEST OF MY KNOWLEDGE. . INFORMATION IS TRUE ANO CORRECT TO S~GNATUaE DATE THE BEST OF MY KNOWLEDGE. . 12_ SIGNATURE DATE
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FOR CITY ·USE ONLX -l03. ExJST
TOTAL FEE REQURIEDI ~ I
DATE FEE PAID I %fd'/2 y
I
RECEIPT NO. I l3;'f f:,
RECEIVED BY:
J'UN 10-1992
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