HomeMy WebLinkAboutRP 06-04; Knockout Burgers; Redevelopment Permits (RP) (4)INSTRUCTION SHEET FOR FILLING OUT
ENVIRONMENTAL INFORMATION FORM
This Environmental Information Form will be used to assist staff in determining what type of
environmental documentation (i.e.. Environmental Impact Report, Mitigated Negative
Declaration, Negative Declaration or Exemption) will be required to be prepared for your
application, per the Califomia Environmental Quality Act (CEQA) and Titie 19 of Carlsbad's
Municipal Code. The clarity and accuracy of the information you provide is critical for purposes
of quickly determining the specific environmental effects of your project.
Any environmental studies (i.e., biological, cultural resource, traffic, noise) that are
necessary to substantiate a "no impact" or "yes impact" determination should be submitted
as an attachment to this Environmental Information Form. This is especially important
when a Negative Declaration is being sought. The more information provided in this form, the
easier and quicker it will be for staff to complete the Environmental Impact Assessment Form -
Initial Study.
ENVIRONMENTAL INFORMATION FORM
(To be Completed by Applicant)
Date Filed: (To be completed by City)
Application Number(s):
General Information
1. Name of project: j^tf^otJutx^ '^V^>tjc'^-^
Name of developer or project sponsor:
Address:
City, State, Zip Code:
Phone Number:
Name of person to be contacted conceming this project: ^ v\ A-VIA C 6
Address: 2^^Z V4?^WvA
City, State, Zip Code: C^^'AX<Z(y/^ ^ Zxpf'
Phone Number: Iioo- ZOl-IM^jC^
Address of Project:
Assessor's Parcel Number: 2^:?"^- 232-0^
List and describe any other related permits and other public approvals required for this project, including
those required by city, regional, state and federal agencies:
6. Existing General Plan Land Use Designation: ^0»^wu.»vzCg<A/\ j
7. Existing zoning district: _
8. Existing land use(s): ^0\j^u. o^iyWK^ ^^^JT/QI
9. Proposed use of site (Project for which this form is filed): \ iScAi.A 5S^^\AVC - l^ Wi/y V^uvic^
t/1 W^vcwfa/i'
Project Description
10. Site size: m S.Z.
11. Proposed Building square footage:
12: Number of floors of construction:
13. Amount of off-street parking provided: '^^c '^^
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14. Associated projects:
15. If residential, include the number of units and schedule of unit sizes:
16. If commercial, indicate the type, whether neighborhood, city or regionally oriented, square footage of sales
area, and loading facilities: K )B'fUltlioMOD c\
17. If industrial, indicate type, estimated employment per shift, and loading facilities:
18. If institutional, indicate the major ftmction, estimated employment per shift, estimated occupancy, loading
facilities, and community benefits to be derived firom the project:
19. Ifthe project involves a variance, conditional use or rezoning applications, state this and indicate clearly
why the application is required:
Are the following items applicable to the project or its effects? Discuss all items checked yes (attach additional
sheets as necessary).
Yes No
20. Change in existing features of any bays, tidelands, beaches, or hills, or
substantial alteration of ground contours.
21. Change in scenic views or vistas from existing residential areas or public Q
lands or roads.
22. Change in pattem, scale or character of general area of project. Q
23. Significant amounts of solid waste or litter. pj^
24. Change in dust, ash, smoke, ftimes or odors in vicinity. Q
25. Change in ocean, bay, lake, stream or ground water quality or quantity, or Q 0^
alteration of existing drainage pattems.
26. Substantial change in existing noise or vibration levels in the vicinity. Q \ZZ
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Yes No
26. Site on filled land or on slope of 10 percent or more. Q YPC
28. Use of disposal of potentially hazardous materials, such as toxic Q [3^
substances, flammables or explosives.
29. Substantial change in demand for municipal services (police, fire, water, []] \2lf
sewage, etc.).
30. Substantially increase fossil fiiel consumption (electricity, oil, natural gas, Q VJT
etc.).
31. Relationship to a larger project or series of projects. Q Q'
Environmental Setting
Attach sheets that include a response to the following questions:
32. Describe the project site as it exists before the project, including information on topography, soil stability,
plants and animals, and any cultural, historical or scenic aspects. Describe any existing structures on the
site, and the use of tiie structures. Attach photographs of the site. Snapshots or Polaroid photos will be
accepted.
33. Describe the surrounding properties, including information on plants and animals and any cultural,
historical or scenic aspects. Indicate the type of land use (residential, commercial, etc.), intensity of land
use (one-family, apartment houses, shops, department stores, etc.), and scale of development (height,
frontage, set-back, rear yard, etc.). Attach photographs of the vicinity. Snapshots or polaroid photos will
be accepted.
Certification
I hereby certify that the statements fumished above and in the attached exhibits present the data and information
required for this initial evaluation to the best of my ability, and that the facts, statements, and information presented
are true and correct to the best of my knowledge and belief
Date: 3 -l3-C?^ Signature: ) *^ c ^
For: V^^^Z^ KM^
02/22/06