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A PII'QT1ON FOR �._ D USE: PE tMi6T, /A�1 �i�E or ._ } 1PJ.0
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APPLICANT`S. NAME: e -
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STATUS QF APPLICANT`S "lNTEREST IN' PROPERTY
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OWNER'S NAME: PHONE:
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DESCRIPTION tJF PROPER3Y; - -
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E%PLAIN °FULLY:REASON FOR SPECIAL USE:.
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The above statements; ai a certified by 'fhe ,undersigned to be correct. -
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NOTE: Tease submit herewith'a check-or money order, in the. arnount shown: below,, payable to County of ,Butte also.a
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detailed plot plan showing the',{ocation ot.existing..and proposed structures on your pro -and on the adjacent.
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Receipt m, _r _ i
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P BOX 922'
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