HomeMy WebLinkAboutPR 4.63; ANDERSEN ENCROACHMENT; Engineering Application• CITY OF CARLSBAD • '
. ENGINEERING DEPARTMENT
ABOVE GROUND ENCROACHMENT PERMIT APPLICATION
PROJECT NAME _____ -+~+-'-'b ..... d ..... e_t .... ,S,,-e_.._1/\~----~----~.,_.,....-------,----'----. ~
LOCATION OF PROJECT: SITE ADDRESS_3 ___ 3.__S-O __ · =--..... \..._I CL==-'-1 ..... l :e...........,, 1---~-----'-------'-' -=G.-=t::__.l-=~.a...,.:~............ac,.__.aa...J ...__,
ON THE -5~~. )eo. ~ SIDE OF --~..........,;.....;;_~S.-=".:::.::;,__;0;.........;;;o_;;o_d~. ___ _ I .
V,, ( \ :orth, South, East West) ~me of Street) J BE1WEEN-__ __.__.._=-.:.._ ""--'-_____________ AND_.:.....LU--'--'CL=-e---..'z:-=---e...-=---1------
-(N:Jne of Street) _
ASSESSOR PARCEL NO(S) ZOfl:-of20 -%,p
(Name of Street)
BRIEF DESCRIPTION OF E~<?ROACHMENT: ~en ce. CLf f?X:: 0 'f. Co 0 I q / a b 8 &~woo
~"' "--'<'O ~ ½ o\ 1 7 " ( J«_..., C.. e \ ',. J ' $," -\so'.'=,, Lu. V: b .e . ./,~;-e)
REASON FOR ENCROAC MENT· 11.-~~ ~ k:: _ Rehc
OWNER
NAME (Print or Type) cl>-' d:? -e. _ H?:7~ SEA-\,_
MAILING ADDRESS: ,3:??,srJ V0-lltt '7 S-, ·
PHONE NUMBER: l, c'; '):a'·_ ss-c> I
I CERTIFY THAT I AM THE LEGAL OWNER AND THAT ALL THE ABOVE INFORMATION IS TRUE AND
CORRECT T HE BEST F MY KNOWLEDGE.
DATE
APPLICANT
NAME (Print or Type) ___ ...... 5_0=m~e.--· ------------------
MAILING ADDRESS: _______________________ _
PHONE NUMBER: _______________ _
I CERTIFY THAT I AM THE AGENT OF THE LEGAL OWNER AND THAT ALL ABOVE INFORMATION IS
TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. -.
SIGNATURE DATE
P:\DOCS\MISFORMS\FRM00056 REV. 8/4/92