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SITE PLAN REVIEW APPLICATION Date: (O /zyV0_�5_ Permit Number (if applicable) APPLICANT INFORMATION Owners Name: Owners Address: Telephone No.: Site Address: Proposed Use: AP# Bin Number Parcel Size: Residential ❑ 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 IM Septic ❑ Agricultural Exempt Building ❑ Other: Brief Explanation/Issue: ❑ Commercial Remodel ❑ Industrial Remodel ❑ Well ❑ Agricultural Buffer Form DEVELOPMENT SERVICES INFORMATION (For Staff Use) Approved ❑ Conditionally Approved Zone: GP: 11 ❑ Resolve Problems Prior to Approval ❑ Resolved Date A)- _W as 1 ALL ITEMS CHECKED APPLY TO THE PROPERTY Parcel Is In: ❑ Williamson Act Minimum Acreage: ❑ Residence can be built per contract ❑ Watershed Protection Overlay Zone [� SRA - (CDF to determine specific requirements) ❑ 100 -Year Flood Plain: • Flood Zone: • Flood Panel No.: Index Date: ❑ 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: General Plan: Applicable Building Setbacks: ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 2 Zoning Code Streets & Highways Fire Prevention Subdivision Map Front Side 10 Side Street Rear to Height Waterway N/A N/A N/A ❑ Setbacks identified on site Plan. ❑ CDF approval needed for encroachments into SRA setbacks. ❑ Use Permit/Minor Use Permit Permit Number: Date of Approval: 2 Ii Parcel Created By: ❑ . 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:❑ 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: VD6, CO Lot: ) Book: Page: OP67 3 \ y. SITE PLAN _ a------------------ - - ..... ___ .............: __ _ �. R. 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Is:_ . ............... ......................... Assessor's Parcel Number. U L M.__j Scale: 1" Owner Name kAYMAI Ro&,(Ness oN /loss /Uj_ -q 93.2 - Address / Phone No. 6 / —rl C C tflA Site Location 4/1 - Contact: Name LjM Phone OcUiber 23, Z03 FOR OFFICE USE ONLY Zoning: General Plan Desig: Size, Acres i 4.0(r PROVIDE FOR ALL ADJACENT PARCELS SIZE (AC): ZONING: GEN PLAN: -USES: