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use Permit Number - i��`�t.�"
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I t'and ttesorlbe ahiy other related permits `and other public approvals requfrdd for thi€e proioot, inotuding'those required by
�jl,; � �
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(t .re lonel'' State
u�v%g + and Faderal dgehalest.r,��1 If.Ylt 1�rrt•rcii t
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ArP, Numumbdrtsf.......
IP RESIDENTIAL TIdL, Include the number of units, whether unite are single or multktory in hplght,,schedule 0 unit altos, and
typ e, of, household size expemado S� tf � e i3m11 -Y
Proof of Agency (if neodedl
i0 GOMMERt IAL, Indicate tho type, whether neiphborho*'city or rogiohdily oriented, aquaro footage of safari stud, a'hd
,
('ceding iaollltids, _
Ir, IN Us'TAIAL, indicate type, estlmotod omploymant por situ(,, ondloadlrrgfoaillil`ds,
pFiNs i rtI PIONgt�, In the rrm�ulor oh ton, Os MOW ontploymont per, shift,; anpinlri�dd o0cupanoyo �loadingfaollltlbs,
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cel j �
Date': l'iO Vr#d ,. 1..; n• w $ `1 ..�� heoplpt Nu ilbee
and community benofito"i to beAaClvdd from the Prolddt.
Appli'datloh tdkon by
eNYiRt7tdiJl ON A. �, UL IMPACT$ ND MltiOA`CION MRAS1.140 *
identify potentially slonlfionht enVlrpnmental Impede assodialod,with the uee perrnit. 'Whet irmrioat ,deshn lraturobor spet91a1
conditions of'appro'v'ot tmitlgatToh.meesuresl'brd prcDoaed to alioulatepotent) bI'd nvirdnmontt iinpaotsl*
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0640AON
s beto s itd*
fbd the p ofdc site A.4 It existn the pteleat, i.Ttoitlding.ihfoCrnaltan on':topographyi oil' stability, pidnts and a
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maigl and any bbOurail,, hiIMa. del or eaenlo ti§peots.t esorlbe any exldting struotures ori the $Itd, and the use df the Mrudturos,
Oasbobe tWSnoundtg prapertles, no[uding Inforrratlan onp ants andahlmold and. 00Y dultural, hiortaat or rroeftle aspects.,
iia.,
Indicate the typo of land use (rdsidOhtlal„ ttommarolal, Oto,) intdnalty of load, use (sloole-famliy, apartmr3Clta, ahcps, depart .
ment- koPt{s,: oto,h and scale of devpi'opm'cnt fhelght,:frantoge, oetbddk, rest yo d, btoo).
*Use separate shdot;far longer rdsponses�
I hordby depfaro unddt penalty of penury that I liavo read and uhdowdod the lnMMOtions and that the (Of OW dtatements
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are true, complete and correct to they best of my krwklodge and bellO
Date':. .� ,., „ ,� .::.�..' Appticdht's sl.gnature -
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Date .�... �� Property owner's elgnaturd
use Permit Number - i��`�t.�"
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oqur,st, t � Uso porrnit to aila�N L
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prtiieot loosdriptfatt
otiing',and ROVINmdrtts
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20 doplod Of blot Pllert
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Appli'datloh tdkon by
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angers the dr�ersxty c�
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a any spe, es, o p: ants c'irxclu4i�. re s,
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'Rdiie.t;aun the, i;luil�ers 0 fany
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at enda.ngbxea .speCies df plaflt:s'
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n ° ' grits nt; 4
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ge, t� any agricultural Crept
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� Will. tho p r�pc��a�. 6a,t�1.t in s�tb`s��i�l����:
Gr a� the
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is all s edicts f ati4uls Cblitds � and an ttt' 11
i a�aluding t dptiles gl,sh
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berithJ6 Orgallift$1 Or,insects)
geduet o i ih the riutnber of Ally`' uniq�e'�
or endhogeted speele of ahim s
G� a it ed, to e .jidwspedi s
all area.J 6 tesult, Ins ', r. a to
the
or fiomiet'1t Of tnarila�
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its. 1Y1 the proposdi result 14ubstsntaa�.
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the ptoposa ices t t i t
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d h T" LIit �j
la , Planted
hd �is� Oi aYt area
NATURAL OU���S y Will the pre esdl
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ai �ne7`ease an .
the' rate (if tzse bf at'17, nb.�t�ral
teux`e5't
1�eplet.xrrY e allyb1=eeWbliatual
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eVeht f gigl A ( lit UP t ditdlti��1s,
b i passible inttr. `erdtiee
With,at�
x'espi�i�St�' p1�ii� dt etrier.,,en� ' r '
�netAtaeti p '
ii
i
tlp.UtATIONi Will the pteposaI alter the 16it,ibn�y
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'9rowth tate Op 'the
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BUTTE' �o
Y PLA,.,
CALIFOR
APP4
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u
ed
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