HomeMy WebLinkAboutRP 11-33; Carlsbad Village Family Practice; Redevelopment Permits (RP) (3)ENVIRONMENTAL INFORMATION FORM
(To be Completed by Applicant)
Date Filed: (To be completed by City)
Application Number(s): U'^S
General Information
1. Name ofproject: Pf^. AJig- ^/?^SB4D \JILLA^ FANlL-Y ff^/iC^nce.
2. Name of developer or project sponsor:
Address: Jefiy^^^SO^
City. State. Zip Code: ^W^-Sg^D , jf^m
Phone Number: 7(gD. llfl, 4^St
Name of person to be contacted conceming this project: Sx^Mg /ZA^XA/^
Address: ^^6^ SHO^^^^
City, State, Zip Code: ^fiOS^ry^^CA ^t^i/
Phone Number: (p^'^td-^^^
Address of Project: iM>\ ^efP^SOAj
Assessor's Parcel Number: '-ilO'-€t?
List and describe any other related pennits 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:
7, Existing zoning district:
Existing land use(s): OfflC^
9. Proposed use of site (Project for which this form is filed): Of^lC^ ^ H^DIML- CUhilC
Project Descnption
10. Site size:
11, Proposed Building square footage; I^THh - tf^M^f. jfJe^^ t^^i.F. JprAL- 2^^^ ^/f
12: Number of floors of construction
13. 3. Amount of off-street parking provided:
02/22/06
14. Associated proiects: KJoN&r
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:
17. If industrial, indicate type, estimated employment per shift, and loading facilities:
18. If institutional, indicate the major function, estimated employment per shift, estimated occupancy, loading
facilities, and community benefits to be derived from the project:
19, Ifthe project involves a variance, conditional use or rezoning applications, state this and indicate clearly
why the application is required: »J/A-
Are lhe following Hems applicable lo lhe project or Us effeds? Discuss all items checked yes (attach additional
sheets as necessary).
20. Change in existing features of any bays, tidelands, beaches, or hills, or
substantial alteration of ground contours.
Yes
•
No,
0
21. Change in scenic views or vistas from existing residentiai areas or public
lands or roads.
ET
22. Change in partem, scale or character of general area of project. •
23. Significant amounts of solid waste or litter. •
24. Change in dust, ash, smoke, fiimes or odors in vicinity. • 0^
25. Change in ocean, bay, lake, stream or ground water quality or quantity, or
alteration of existing drainage pattems.
• &^
26. Substantial change in existing noise or vibration levels in the vicinity.
3
•
02/22/06
7
26.
Ves No^
Site on filled land or on slope of 10 percent or more. [_J 0
28. Use of disposal of potentially hazardous materials, such as toxic 0^
substances, flammables or explosives.
29. Substantial change in demand for municipal services (police, fire, water, Q [y/f
sewage, etc.).
30. Substantially increase fossil fuel consumption (electricity, oil, natural gas, [[] jvT
etc.).
31. Relationship to a larger project or series of projects. Q
Environmental Setting
Attach sheets lhat include a response to the following questions:
32. Descnbe 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 the 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 lhat the facts, statements, and information presented
are true and correct to the best of my knowledge and belief. '
Date; tt-O'^.H
02/22/06