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Ewk4* USE ONLY
Aw Plan AtInchad V.,
Aa7L Man Atweted ---, ,-y7
Seni t, S.D.
TO: Building Department
FROM: Environmental Health
SUBJECT: Sanitation Clearance
CO I -n 434; Cl�
Af
/Owner 1-6cation AP#
Plan Approved for:' Sewage Disposal Water'Supply: Public Private Well
Clearance for — dwelling. Other
Hold final for:
Final c177e O.K. for:
NOTE:
Environmental Healt"becialist Date
8/96
COUNTY OF AUTTE
Department of Development°Services
Building Division
Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541
Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signature.
Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and
issuing your building permit. No building permit will be issued until this verification is received.
1. I personally plan t provide the major labor and materials for construction of the proposed property improvement
(yes or no)l>
2. I (have/have not) signed an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name
Address City
Phone Contractor's License No.
4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and
provide the major work:
Name
Address City
Phone Contractor's License No.
5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner
Social Security Number
Date / — l — 54:
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before we are permitted to issue the
permit.
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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
=f
School District 01-4 6) (J .f/ / a 11G/ S Building Department No.
A.P. Number o'W: 3�d �Q .�� Jurisdiction 0 City County
PropertyOwner
Property Location/Address
Subdivison Lot No.
Residential Development Sq. Footage .�
No. of Living_ , MHI Addition ( up R)
Units
Commercial/Industrial 0 Sq. Footage
f . New Addition (Including Exterior
oofed reas)
B ilding Departme epresent tive Date
(Floor Plans reviewed by School District Personnel)
ict Identification No. 950076
w o rIlAh'
>7t l School District certifies that . M t�, c o� CL
(Applicant)
(street address) f �. l . (Phone Number)
(City) (State) - (Zip Code)
has complied with the requirements of Resolution No. J� — C/�� by payment of $ Q
representing square feet.. Check here if fee received represents "Full Mitigation".
A
School D
Date
Paid by Check # � Remarks:
Bank Number
Paid by Cash
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feefcrmmkf (4/94)
COUNT' OF BUTTE
Department of Development Services
Building Division
Oroville: 7 County Center Dr., Oroville CA 95965 Ph: 916-538-7541
Chico: 1469 Humboldt Rd., Chico CA 95928 Ph: 916-891-2751
OWNER -BUILDER VERIFICATION
Attention Property Owner:
An "owner -builder" building permit has been applied for in your name and bearing your signature.
Please complete and return this information at your earliest opportunity to avoid unnecessary delay in processing and
issuing your building permit. No building permit will be issued until this verification is received.
1. I personally pla prh abor a materials for construction of the proposed property improvement
(yes or no)
2. I (have/have not an application for a building permit for the proposed work.
3. I have contracted with the following person (firm) to provide the proposed construction:
Name '
Address City
Phone Contractor's License No.
4. I plan to provide portions of this work, but I have hired the following person to coordinate, supervise, and
provide the major work:
Name
Address City
Phone Contractor's License No.
5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated:
Name Address Phone Type of Work
Signed:
Property Owner , F/,4" X��
Social Security Num r
Date
NOTE: This Owner -Builder Verification is sent to you as required by Sections 19831 and 19832 of the California
Health and Safety Code.
This verification must be completed and returned to our office before we are permitted to issue the
permit.
PRINTED ON 1000H-8 CLEARPRINT
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