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HomeMy WebLinkAbout058-330-025David Whittier Consulting Forester Lic. #2643 P.O. Box 5331 Oroville, CA 95966 (530)589-1479 Fax #(530)589-0950 e-mail:whittiers@jps.net June 2, 2006 CA Dept. of Forestry and Fire Protection 6105 Airport Road Redding, CA 96002 Dear Sirs & Madams; Enclosed is a one-time conversion request for one parcel owned by Henry (Ted) Runge. He is a developer and is in the business of buying and selling property. In the future more conversions will be filed for driveway and septic systems. I have spoken to Shane Cunningham and this is the way he suggested to handle the conversions that will be coming now and in the future. Ted is the timber and timberland owner for parcel 058-. 330-025. The intent is to make room for a septic system and driveway on the parcel. All trees have been marked with a blue take tree mark including butt mark. The marking was done with the owner and is intended to clear the area for the above mentioned use. The LTO will remove the trees for the above mentioned use. The LTO will also be responsible for treating the slash generated by the operation to the standards of Section 1104.1(2)(d) of the Forest Practice Rules. The exemption area boundaries are flagged in solid pink flagging. Access to the parcel will be by the existing road off Hoffman Road. No watercourses are present. No endangered or threatened plant or animal species were observed. Habitat for such species was not noted. No archeological sites were observed. This project is in accordance with Butte County regulations and the Butte County designee has signed off on its compatible use. A copy of the notice posted on the parcel at least 5 days before submission (copy of notice attached, posted (May 11, 2006). A copy of the notice was sent to owners of record within 300 feet and the archeological contacts for Butte County (June 2, 2006). A list of the adjacent property owners are enclosed. Sincerely � f David Whittier Registered Professional Forester #2643 LESS THAN 3 ACRE CONVERSION EXEMPTION FOR ADMIN. USE ONLY STATE OF CALIFORNIA Ex. # DEPARTMENT OF FORESTRY AND FIRE PROTECTION NOTICE OF TIMBER OPERATIONS THAT ARE EXEMPT FROM Date of Receipt CONVERSION AND TIMBER HARVESTING PLAN REQUIREMENTS RM -73(1104.1 a) (9/99) Date Accepted VALID FOR ONE YEAR FROM DATE OF RECEIPT BY CDF Date Expires TIMBER OPERATIONS CANNOT START UNTIL VALID COPY OF A NOTICE OF ACCEPTANCE IS RECEIVED FROM CDF The Director of the Department of Forestry and Fire Protection is hereby notified of timber operations under the requirements of 14 CCR 1104.1(a). Harvesting of trees which is a single conversion to a non -timber growing use of timberland of less than three acres. (See 14 CCR 1104.1(a) for a description of the conditions on the conduct of this type of Umber operation, and additional information that is required to be submitted.) Complete Items 1. through 8. on both pages of this notice. 1. TIMBER OWNER(S) OF RECORD: am Address City nrnvillp State CA Zip 95965 Phone 01-5-U-'1696 ~g � SIGNATURE�,•��!fk� 770- 4g. '— � � Date TIMBER TAX EXEMPTION: Timber owners owe timber yield tax when they harvest trees unless the harvest is exempt (Revenue and Taxation Code sec. 38116). -Some small or low value harvests may be exempt from timber yield tax: Timber removed from an operation whose value does not exceed $3,000 within a quarter, according to BOE Harvest Value Schedules, Rule 1024. If you believe your harvest may quality for this exemption, please complete items A and B below. For timber yield tax information or for further assistance with these questions call the state Board of Equalization, 1-800-400-7115, or write: Timber Tax Section, MIC: 60, State Board of Equalization, P.O. Box 942879, Sacramento, California 94279-0060; or contact.the BOE Web Page on the Internet at http://www.boe.ca.gov. A. Circle the option that most closely estimates the total volume for this ha thousands of board feet (mbf - Net Scribner short log): Under 8 mbf 8-15 mbf 16-25 mb Over 25 mbf B. Estimate what percentage of Umberto be removed during this harvest will Redwood %; Ponderosa pine/Sugar, Rn %; Douglas -firms—%; Fir %; Port -Orford Cedar %; Cedar (IC, WRC) %; Other, conifer %; Other, hardwood%. 2. TIMBERLAND OWNER(S) OF RECORD: Name Same ac #1 Address City _ State Zip Phone I certify, under penalty of perjury, that this is a one-time conversion to a non -timberland use, that there is a "bona fide intent' ]14 CCR 1100 (b)] to convert to a�f l� andto icSysstem and that I have mailed a fetter of notice of intent to harvest timber, prepared by the Registered Professional Forester, to all adjacent landowners within 300 feet of thcr6Durldaries o(tbeAzefflptign. SIGNA 3. LICENSED TIMBER OPERATOR(S): Name WHI42m rhricman Lic. No. A95170 Address P 0 Box 59 City SIGNATURE `/y C/fit . 5`/r"r.IVcok. –+ vaic 4. Designate the legal land description of the location of timberland conversion. A map showing the location of the timberland conversion MUST be attached. The map must show the ownership boundaries, the location of the Umber operation, boundaries of the conversion, location and classification of all watercourses, and landing locations. Section Township Range Base & Meridian County Acreage to be Converted Assessors Parcel Number –� –M__ –AE_ —M r) R RM _ _Butle _ n5R-inn f175 Page 1. NOTE: This form has two pages. Continue on and complete Page 2. Read the instructions before attempting to complete. LESS THAN THREE ACRE CONVERSION EXEMPTION, Page 2. 5. The following are limitations or requirements for timber operations conducted under a Less Than Three Acre Conversion Exemption (Notice, Notice of Conversion Exemption, Conversion Exemption): A. Timber operations shall comply with all other applicable provisions of the Forest Practice Act and regulations, county general plans, zoning ordinances, and any implementing ordinances; copies of the state rules and regulations may be found on CDF's Web Page on the Internet at http:/Awiw.fire.ca.gov. B. All timber operations shall be complete within one year from the date of acceptance by the Director. C. All conversion activities shall be complete within two years from the date of acceptance by the Director unless under permit by local jurisdiction. Failure to complete the conversion requires compliance with stocking standards and stocking report requirements of the Act and board regulations. D. The timber operator shall remove or dispose of all slash or woody debris in accordance with 14 CCR 1104.1 (a) (2) (D). The timberland owner may assume responsibility for the slash treatment, provided the landowner acknowledges in writing to the Director such responsibility at the time of submission of this notice. The specific requirements shall be included with the acknowledgement. E. Timber operations shall not be conducted during the winter period unless a winter operation plan or in lieu practices required by Forest Practice regulations are specified within (attached to) this Notice. F. No timber operations are allowed within a Watercourse and Lake Protection Zone unless specifically approved by local permit (e.g. . county, city). G. No timber operations shall be conducted until the Director's notice of acceptance is received and a valid copy of this Notice and the Director's acceptance shall be kept on site during timber operations. H. No sites of rare, threatened or endangered plants or animals or species of special concern shall be disturbed, threatened, or damaged. I. No timber operations are allowed on significant historical or archeological sites. J. Within one month of the completion of timber operations, including slash disposal, the timberland owner shall submit a Work Completion Report to the Director. '±Z& fK rte, , ��.,� 1, an �g,�ct�nf planner � Adeclare as the authorized designee of the County Board of Supervisors that this conversion exemption is in conformance with all unty regulatory requirements, including public notice. (If the county has authorized a desigdbp this item INJIJST be completed. If it has not, see Rem 7.) 7. Registered Professional Forester preparing Notice: Name navid Whiffler Number W City Ornville State CA lip 95986 Phone 530-SR9-1479 1 certify that 1, or my supervised designee: prepared this Notice of Conversion Exemption Timber Operations; visited the site and flagged the boundaries of the conversion exemption, applicable WLPZ's and equipment limitation zones; prepared a notice according to 14 CCR 1104.1(a)(3) to be mailed by the landowner and that a copy of the notice was posted and dated on the ownership, visible to the public, at least 5 days prior to the postmark date of submission of the Notice of Conversion Exemption; and that if the County Board of Supervisors has not designated a representative authorized to sign in ftem 6., that 1, or my supervised designee, contacted the county and lice is in conforms ce with county regul@kons. n SIGNATURE of RPF ISL ` j nate � /06 8. NOTICE SUBMITTER(S): Name Rame ac #1 Address P o rQ o K a 0 kf Q - City O o State C lip S 6 hone Submitter must be either 1, 2, or 3 above, and must sign. SIGNATURE. x ate FILE THIS NOTICE WITH THE NEAREST CDF OFFICE BELOW FOR THE COUNTY IN WHICH THE OPERATION WILL OCCUR: Humboldt, Del Norte, Mendocino, Sonoma, Marin, Lake, Napa, Colusa, Solano, Alameda, => 135 Ridgway Avenue San Mateo, Santa Cruz, Santa Clara, Contra Costa, and western Trinity Counties. => Santa Rosa, CA 95401 Siskiyou, Modoc, Shasta, eastern Trinity, Lassen, Tehama, Glenn, Butte, Sutter, Plumas, => 6105 Airport Road Yuba, Sierra, Nevada, and Placer Counties. => Redding, CA 96002 EI Dorado, Amador, Alpine, Calaveras, Tuolumne, Mariposa, Merced, Madera, Fresno, Tulare, => 1234 East Shaw Avenue Kem, Stanislaus, San Benito, Monterey, King, San Joaquin and Sacramento Counties. => Fresno, CA 93710 Ventura, Los Angeles, San Bemadino, Orange, Riverside, Inyo, Mono, San Diego and => 2524 Mulberry Street Imperial Counties. => Riverside, CA 92501 Runge Hoffman Road Conversion Exemption Paradise East 7.5' quad Section 10, T22N, R4E, MDB&M Scale lin. = 700 ft. T North Contour interval 40ft. Parcel Boundary............ �--- Exemption Boundary...... �--- Existing seasonal road... Landing Location ........ a,_ . Si ye .. n 1L al. .s _._ Lam. ��� •��- � i� �� ���� �� � ��� - �'. tAA 1 s fry $ P� i gg if •P 92� s� =� ' z . CD s z CD is � � v �.e�# �� 1 .���..• �a.' ���.�� o3��ys_�`•. "y �.' � ��"'` - ,cc a _� �c .rsc�r � r ee IF y, e� m ` w+ !nil Ill o; Y iy VIl CD—a� '`y... Lamm z.r .In .:..L Parcel Boundary............ �--- Exemption Boundary...... �--- Existing seasonal road... Landing Location ........ Location -Map Range Hoffman Road Conversion Exemption Paradise East 7.5' quad Section 10, T22N, R4E, MDB&M Scale 1 in. = 800 ft. SW //4 SEC. 3 Q NW //4 SEC. /O, T 22 N, R 4 E M. O. B. 9 M. Parcel Boundary......... Exemption Boundary.' �}f--- REVISED: 7-88 33 -33 6ou47y a7 ttar7e, coif. David Whittier Consulting Forester Lic. #2643 P.O. Box 5331 Oroville, CA 95966 Office: (530)589-1479 May 11, 2006 To Whom It May Concern: An Exemption for a less than three acre conversion will be mailed to the California Department of Forestry and Fire Protection, 6105 Airport Road, Redding, CA 96002, (530) 224-2445, on or after May 9, 2006 for the Timber/Timberland owner listed below. The conversion is a one-time change of use from Timberland to a Driveway and septic system. Trees marked with blue paint will be harvested to provide space for all of above. A copy of this notice will be posted on the parcel at least five days prior to mailing of the exemption to CDF. Each property owner of record within 300 feet will be mailed a copy of this notice immediately prior to the exemption being mailed to CDF. No watercourse is present in the exemption boundaries. No archeological sites are located in the exemption area. Parcel #058-330-025, located in Section 10, T22N,' R4E, M.D.B. & M., in Butte County. Henry (Ted) Runge, Timber & Timberland owner, 2415 Fifth Ave., Oroville, CA 95965, (530)534-3626 The Licensed Timber Operator is: William Chrisman, P.O. Box 58, Berry Creek, CA, 95916, (530)589-3472, LTO #A-9500. Sincerely, David Whittier Registered Professional Forester #2643 BUTTE COUNTY DEPARTMENT OF PUBLIC HEALTH DIVISION OF ENVIRONMENTAL HEALTH SEWAGE DISPOSAL PERMIT 411 MAIN STREET • P. O: BOX 5364 7 COUNTY CENTER DRIVE CHICO, CALIFORNIA 95927 OROVILLE, CALIFORNIA 95965 TEL: (916) 891-2727 TEL: (916) 538-7281 FAX: (916) 895-6512 FAX: (916) 53&2140 f kk � Date Issued / 7 U EXPIRES ONE YEAR FROM DATE OF ISSUANCE Permit Issued to To construct a sewage disposal system or: �_i Located at: ',YV'. , i A.P. # SEWAGE DISPOSAL SYSTEM REQUIREMENTS SEPTIC TANK Liquid capaci ��%� gallons I Material L.% .Y�il .► r -r? { I z LEACHING FIELD Total length: ."L'L= feet Trench width: t` inches Minimum No. of lines: Rock under pipe ' inches Additional leaching fieldwill be required if experience shows it to be necessary. No part of the system may be located within 50 feet of the center line of any County Road. NOTE: Satisfactory inspection by the Health Department is required before backfilling or putting the system into use. Occupancy of a new building is not permitted until the system is approved. Permit Fee $ Penalty Fee $ Additional Fee $ Receipt No. S31 - 278R (Rev. 6/94) TOTAL FEE $ Issued By: E I6&NTAL HEALTH SPECIALIST .y SITE PLAN REVIEW APPLICATION Date: JAAJ AP# Permit Number (if applicable) ADAT Tr'd NT rATFnRAIA TTnN Parcel Size: Owners Name: Owners Address: Telephone No.: Situs Address: Proposed Use: <_Y. -)/ el" L/) Residential ❑ New Single Family Residential ❑ Single Family Addition ❑ Single Family Remodel El Mobile Home - -'-- - . ❑ Residential Accessory = - ❑ Permanent Second Dwelling ❑ Temporary Mobile Home (Aunt Minnie) ❑ Temporary Travel Trailer- ❑ Multi -family )Von -residential ❑ New Commercial ❑ Commercial Addition ❑ New Industrial ❑ Industrial Addition Other 0 Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation (if necessary): ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well DO NOT WRITE BELOW THIS LINE DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval Site PI Stamped Approved By Date d7 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: Q� Snow Load Area: •,,2600 -to .25004 ❑ Land Conservation Act Minimum Acreage: ❑ Verify residence can be built per contract ❑ Nitrate Action Plan (See Environmental Health for standards) ❑ Watershed Protection Overlay Zone (See attached standards and requirements) Expansive Soils (Test for expansive soils and if verified proper foundation design required) SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: Wached) Flood Zone://11®rn�ia Flood Panel No.: gOOL Index Date: (0 ❑ Sacramento River Reclamation District (Approval must be obtained from the Reclamation Board) ❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board) ❑ North Chico Specific Plan (See Development Fees Section and attached standards and requirements) ❑ Chapman/Mulberry (See attached standards and requirements) ❑ Cohasset Area (See attached standards and requirements) ❑ Grading Zone (See attached handout) Use Requires: ET Use Permit ❑ Minor Use Permit ❑ Administrative Permit _ ❑ _ Minor -Y. ariance ❑ Variance ❑ Detached,Buildirig Use Fern ❑ Encroachment -Permit r-- - -- -~ -❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement zoning: f4 -:to _ Applicable Building Setbacks: Zoning Code Streets & Highways Fire Prevention Subdivision Map Front#XIJA SideSide Street RearHeight WaterwayN/A N/A ❑ Setbacks drawn on site Plan, ❑ CDF approval needed for encroachments into SRA setbacks. Applicable Development Fees: Standard Fees ❑ Fire ❑ School* ❑ Parks/Recreation ❑ Roads ❑ Sheriff ❑ Drainage ❑ NCSP/CSA 87 ❑ Chico Urban Area — Road ❑ Thermalito Impact ❑ Other Subdivision Map Special Fees Amount Formula ❑ Water Tender ❑ Road Improvement R ❑ ,North Oroville Area ❑Other (per map) #� Check with school district to verify actual fee if pre -application -review. A -final determination will'be made, at, ttie time of - the building permit Parcel Created By _ Deeds: - Date of Creation: -7 1,6010 Legal Access Provided: ❑ No go Yes Deed of Reference: / JF P& Legal Access Required ❑ No Eyes Parcel Frontage on Publicly Maintained Road: ❑ No It Yes, Road Name: Complies with County Standards for Deed Creation:❑ No 41,Yes ' Comments: f2 Parcel Deemed to be legal ❑ Verify Legal Parcel 0 Verify Legal Access ❑Provide Deed of Creation ❑ Obtain a Certificate of Compliance ❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment ❑ Comply with Old Subdivision Lot Ordinance (Maps recorded prior to Book 17 of Maps Page 23). ❑ Construct road to: ❑ Meet Parcel size required by zone ❑ Meet current Environmental Health Department requirements ❑ Subdivision Map/Parcel Map: Map Date of Recording: Lot: Book: Page: ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: Parcel Map/Subdivision Map/Use Permit Conditions ❑ Comply with the following Conditions of Approval: ❑ Meet the Fire Safe Regulations of Butte County and P.R.C. 4290 ❑ Automatic fire suppression sprinkler systems shall be installed in accordance with the National Fire Protection Association Standard for installation of sprinkler systems in one and two family dwellings and mobile homes, NFPA Standard 13D, unless a pre§surized community water system, with hydrants that meet the Fire Department specifications, serves the parcel. ❑ -.Wood stoves and fireplace inserts shall h- ,EPA approved and designed to meet the emission ..requirements of the Califoriva-Clean,Air Act -of 1988, as amended.. Provide an erosion control plan-for,building and -land -disturbance: The Erosion Control -Plan must be prepared by a registered civil, -engineer or other qualified professional and be submitted to and approved by the Departmeni of Public Works. ❑ In lieu of a pressurized water system or water storage tank, payment into the appropriate Battalion Water Tender Fund may be required. ❑ Measures shall be taken to control fugitive dust emissions from all driveway and other civil construction associated with residential development.. Approved dust control measures are found in the fugitive dust control plan for the site approved by the Butte County Air Quality Management District, a copy of which can be obtained from the Butte County Department of Development Services, Building Division." ❑ Engineered foundations are required. ❑ Class A roofs are required ❑ Property owners responsible for roa Summary of Specific Requirements: This information provided in this summary is based on the application information and on the best available data at the time of review. C:1LmTys\Building Permit Site Plan Reviewl.doc - _� - ll1�Al\ 1 L.i t:L 6J �Wtk/VtOuvu/ UVJ vCJ�'V� TA_ X PAID For value received FISC I BROS . INC. GRAMS ............. to i HYRLE E. SHAW and JOYCE M. SHAW, husband and all that ml property situate in the wife as Joint Tenants SountY_ of .-_--••- _Bgtte __ . Smmw of CaWornia, described as follows: 4.eing a portion of the Southwest quarter•of Section 3, and also being a portion of the Northwest quarter of Section 10, Township 22 Korth, Range.4 East, I.D.B. is ., and more narticularly described as follows; Commencing at the [Forth quarter corner of said Section 10;' thence leaving said North quarter corner on and along the North and South centerline of Section 3, Township 22 North, Range 4 E-st, `I.D.B. & N. North 000 12' Last, 30.00 feet. to a point on the centerline of a 60.00 foot road easement; thence.on and along said centerline, North 690 54' West, 461.39 feet to the true nuint of beginning ;for the parcel herein described; thence from said true 3oint of beginning, leaving said road centerline, South 01' 49' 23" West, 732.00 feet; thence South 070 20' 34" East; 526.16 feet to the Southerly line of the parcel of land ee- scribed in deed from F'-enry J. Hoffman, et ux, to Fisci Bros., Inc., dated July 15, 1966 and recorced August 4, 1966 in ncok 1433 of butte. County Official Records, at )age 265; thence along said Southerly and Westerly lines thereof South 620 19' 03" Wiest, 171..00 feet; thence--, North Ol° 49' 23" Fast, 1338.96 feet -to a point on the said ce,�n.terline..,. of, safd 60.00' foot road .easement; thence on and along saifi�centerlfne,rt:'- -South 760 451---30'-=• Fast, -14.39 feet; thence South 89' 54.1..-cast,-50...b�_ ;feet to -the point of beginning and containing 2.51 acres more or less. Reserving therefrom a non-exclusive easement to be used in'common _with others for road purposes and )ublic utility ?urposes over the -North -30.00 feet of the above described parcel. TOGETHER WITH a non-exclusive right of way for road purposes anrd public utility purposes over a 60.00 foot stria of land lying 30.00 feet on either side of a centerline described as follows: Beginning at the Northwest corner of the above described parcel; thence South 761, 45' 30" East, 14.39 feet; thence South 890 541 Fast, ;12.00 feet to a point in the North and South centerline of the aforesaid Section 3. b above. TIKG THsREFRQII that po artion lying within the parcel of land described above - . _ , ALSO TOGETHER.'dITH a non-exclusive right of way over a strip of land 60.00 feet in width; the South line of said right of way being described as follows: beginning,at the quarter section corner common to Section 3 and 10, im rownshi, 22 North, Ringe 4 East, H.D.as. & H.; thence runnAng F':asterly ^� r along the South line of that certain nrooerty conveyed to L. A. Schager, et ux by deed dated July 8 1955 and recorded July 12 1955 a dis- tance FC -� of 720 feet; thence North 11° 32' East, and running along the Cy -South line of oro.c-.rty of L. A. Schager, a distance of 147 feet; thence North 560 .18' Fast along said L. F. Schager property 774 feet; thence South 660 26' East and along the Southerly. line of said L. A. Schager property, a distance of 445.54 feet to the Northwest corner of that -certain property conveyed to r. S. ::arshall, dated October 30, 1942, and recorded December 3, 1942, in cook 305 of Official Records, at page 473; thence along the Northerly line of property of said F. S. .4arshall, Easterly to the Easterly line of Section 3, said point being ^ . 381.5 feet Northerly of the Southeast corner thereof, and the end of nUocurner`.. j T-_�pf.. T--.. $..... (p. .� >t::_ Title Co. es irm1mc` J by .-- _ - — - -- -- - - c.� s..,dss-v.'~-�z• 1. - t u « Esc .� _ IN g}I@'1k W11[EF&&bF la cospoiation flus ezoaate3_t$ie.e prc ►es by its officers. thereunto duly authorized. this — 3� day o{ _G� 19 ... VIVIAN M.'HOLI)6I 6e NOTAer NCLIC CALltot'lu /EINCI►AL OFFICE IN _ _ _ _- _ Q(Day C—d"I— E -U. S.A. �,••c� .•�J • �rt. t _.--yJJJJJJ ratyof�YLAtitre By am-' � '��•�S__-�._._.___._t__ Ow before For Recorders Use Only • . . . a Notary Pablie, in a+d if f JAU �S�X�.G _.Cosatg ani S., -74168penatvUy apared s. "Cam to me OFPIC•-L RECORDS ta-i,rAd� _3a atr..drba c••trej BUTTE r,,USIY-CSLIF of the corpomrion the creested the aritbin iaanamenr. and aro baorcu to = E' : T t.'h= S T!-* I BY as to he the penowr Who =fmftd it on WWI of tush eorponvios, and OROVILLE TITLE COMPANY Ache Wledged to we tbat such corporeiom trocared the .eco, s;' fartbor R ac.4waadedged to. the the tach c�eporeiva esecated the tubi. iaunrnaar AG 7 10 2i Mi 1969 partcaw to its byl� or . suolatio .7 Notary PiUkCOUBTY i,iCd.6Eft K My tunseiuioe arpirat �1'/- �� _ t ^ EEE WLen recorded mail co: 0 A;,QA 77X i1.ry2�.v..srTl Tm; Addams• 5543...��e. 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'a. .t.1 ° °9 .. ... :•� ti y Assessor's Parcel Number Owner Name 3-1 -1-- Address / Phone No. ©oa-aa ° 91®— v ®..Scale: 1 C t- -e ll- i .5�1A - LA L ( •2 C (--p, 4-�-a. v i l (" Cq C � S'7 Site Location i� t E r e, � ;j [�-0 >~ D Contact: Name ►U ° A L A'Z— i Phone S\3 U FOR OFFICE USE ONLY Zoning: General Plan Desig: Size, Acres 4.0(r PROVIDE FOR ALL ADJACENT PARCELS SIZE (AC): ZONING: GEN PLAN: USES: