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SITE PLAN REVIEW APPLICATION
Date:
Permit Number (if applicable)_
Owners Name:
Owners Address:
Telephone No.:. "
Situs Address:
Proposed Use:
Parcel Size: I�� �`—
Residential
❑ New Single Family Residential
❑ Single Family Addition
❑ Mobile Home
❑ Residential Accessory -
❑ Permanent Second Dwelling
❑ Temporary Mobile Home (Aunt Minnie,
❑ Temporary Travel Trailer
❑ Multi -family
❑ Single Family Remodel
M
Non-residential
❑ New Commercial
❑ Commercial Addition ❑ Commercial Remodel
❑ New Industrial
❑ Industrial Addition ❑ Industrial Remodel
Other
Septic ❑ Well
Agricultural Exempt Building
❑ Other:
Brief Explanation (if necessary):
DO NOT WRITE BELOW THIS LINE
DEVELOPMENT SERVICES INFORMATION (For Staff Use)
Approved ❑ Conditionally Approved ❑ Resolve Problems Prior to Approval
Site Plan Stamped Approved
or
ALL ITEMS CHECKED APPLY TO THE PROPERTY
Parcel Is In:
❑ Snow Load Area:
❑ 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 FIood Plain: (See attached)
Flood Zone: x
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 (See Development Fees Section and attached standards and requirements)
❑ Chapman/Mulberry (See attached standards and requirements)
❑ Cohasset Area (See attached standards and requirements)
El Grading Zone (See attached handout)
Use Requires:
❑ Use Permit ❑ Minor Use Permit
❑ Minor Variance ❑ Variance ❑ Administrative Permit
❑ Detached Building Use Form ❑ Encroachment -Permit
❑ Agricultural Worker Affidavit ❑ Agricultural Acknowledgement Statement
Zoning:_ Jj �CprQ /
Applicable Building Setbacks:
Front
Zoning Code Streets & Highways Fire Prevention
Side
Side Street I
Rear
Height
Waterway N/A N/A N/A
Subdivision Map
❑ Setbacks drawn on site Plan, ® CDF approval needed for encroachments into SRA setbacks.
/.
•
Applicable Development Fees:
Standard Fees
❑ Fire
❑ School*
❑ Parks/Recreation r
❑ Roads
❑ Sheriff
❑ Drainage
❑ NCSP/CSA 87
❑ Chico Urban Area — Road
❑ Thermalito Impact
❑ Other
Subdivision Map Special Fees
❑ Water Tender
❑ Road Improvement
❑ North Oroville Area
❑ Other (per map)
Amount
Formula
Check with school district to verify actual fee if pre -application review. A final determination will be made at the time of
fife building permit.
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 � � 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
M
Subdivision Map/Parcel Map:
Map Date of Recording: peFG. ?, l I $
Lot: Z
❑ Use Permit/Minor Use Permit
Permit Number:
Book: �7 Page:____L_—
Date of Approval:
Parcel Map/Subdivision Map/Use Pernut 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 pressurized
community water system, with hydrants that meet the Fire Department specifications, serves
the parcel.
❑ Wood stoves and fireplace inserts shall be EPA approved and designed to meet the emission
requirements of the California 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 Department 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
rol
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FROM: Environmental Health
SUBJECT: Sanitation Clearance -
Owner Looc�-a�ytiion AP#
Plan Approved for: Sewage Disposal Water Supply
Hold final for: Water Supply'
^inal clearance O.R. for:
Clearance for -3 bedroom home. ther
Sanitarian
Water Supply
SITE PLAN
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Assessors Parcel Number. ®Q — ®Q — a L `a Scale: 1" _ .5- 5' a0,�m� e
Owner Name
Address / Phone No. k-
Site Location r
Contact Name �� . , '^. �, \:= Phone
Uodober-.36= .
Zoning:
General Plan Desig:
Size, Acres
a.00r
PROVIDE FOR ALL
ADJACENT PARCELS
SIZE (AC):
ZONING:
GEN PLAN:
USES: