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SITE PLAN REVIEW APPLICATION
Date: ! Z I AP#
Permit Number (if applicable� , Bin Number
)\ a)Rd
APPLICANT INFORMATION . Parcel Size: J
Owners Name: ? S Cci AU_A I A n)
Owners Address: 611! 1
Telephone No.:
Site Address:
Proposed Use: Zone:'��
Residential GP: 1
❑ New Single Family Residential
❑ Single Family Addition
❑ Single Family Remodel
❑ Mobile Home
❑ Residential Accessory
❑ Permanent Second Dwelling
❑ Temporary Mobile Home (Aunt Minnie)
❑ Temporary Travel Trailer
❑ Multi -family
Non-residential
❑ New Commercial
❑ Commercial Addition
❑ New Industrial
❑ Industrial Addition
Other
Septic
❑ Agricultural Exempt Building
❑ Other:
Brief Explanation/Issue:
0
❑ CommercialRemodel
❑ Industrial Remodel
❑ Well
❑ Agricultural Buffer Form
DEVELOPMENT SERVICES INFORMATION (For Staff Ise)
` ] Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval
❑ Resolved
t, X0,1
By Date
ALL ITEMS CHECKED APPLY TO THE PROPERTY
Parcel Is In:
❑ Williamson Act Minimum Acreage: ❑ Residence can be built per contract
9Watershed Protection Overlay Zone
SRA - (CDF to determine specific requirements)
❑ 100 -Year Flood Plain:
• Flood Zone:
• Flood Panel No.: Index Date:
El Sacramento River Reclamation District (Approval must be obtained from the California Reclamation Board)
❑ Feather River Reclamation District (Approval must be obtained from the California Reclamation Board)
❑ North Chico Specific Plan
❑ Chapman/Mulberry
❑. Cohasset Area
Use Requires:
❑
Use Permit
❑
Variance
❑
Agricultural Worker Affidavit
❑
Administrative Permit
❑
Minor Use Permit
❑
Minor Variance
Zoning:
Applicable Building Setbacks:
General Plan:
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&41-
❑ Setbacks identified on site Plan. [CDF approval needed for encroachments into SRA setbacks.
❑ Use Permit/Minor Use Permit
Permit Number:
Date of Approval:
Zoning Code
Streets & Highways
Fire Prevention
Subdivision Map
Front
Side
� r
S
� 0 "W
k s`
Side Street
Rear
S-(
Height
Waterway
N/A
N/A
N/A
D rr c
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&41-
❑ Setbacks identified on site Plan. [CDF approval needed for encroachments into SRA setbacks.
❑ Use Permit/Minor Use Permit
Permit Number:
Date of Approval:
Parcel Created By:
Q . Deeds:
Date of Creation: Legal Access Provided: ❑ No ❑ Yes
Deed of Reference: Legal Access Required ❑ No ❑ Yes
Parcel Frontage on Publicly Maintained Road: ❑ No ❑ Yes, Road Name:
Complies with County Standards for Deed Creation: El No ❑ Yes
Comments:
❑ Parcel Deemed to be legal
❑ Verify Legal Parcel ❑ Verify Legal Access ❑ Provide Deed of Creation
❑ Obtain a Certificate of Compliance
❑ Obtain a Merger ❑ Obtain a Lot Line Adjustment
❑ 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: a Page:
3
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owner
Addre
Site Lc
Contag
umber: F-1 Q Scale: 1" = IQ -4�T
4
O. C,�ca•`o -�% da`i'car �1 ter' e -
Phone 533 --53 S �,/ aftbwaMM
FOR OFFICE USE ONLY PROVIDE FOR ALL
ADJACENT PARCELS
Zoning: SIZE (AC):
General Plan Desig: ZONING:
Size, Acres GEN PLAN:
4.0(r USES: