HomeMy WebLinkAboutADM 97-01-CLOSED AUNT MINNIEAbFILE NO / l
PROJECT TYPE
APPLICANT: bp
b�
ADDRESS:
OWNER:
ADDRESS:
REPRESENTATIVE:
ADDRESS:
PROJECT DESCRIPTION:
r PROJECT SUMMARY SHEE& , ,
PROPERTY ZONED: A, H- I LOCATED: &A / MA ^u� Q2prO'Y
a "),b
AP NO.: (J� OWN/AREA:_ • 1. C�C�
GENERAL PLAN DESIGNATION: ��
1. Application Complete: Amount: Receipt No.:
2 Comments sent to:
3. Comments received from:
4: Rezone Petition Signatures Checked:
5. Melling UstlLead-In Sheet:
6. Assigned To:
7. Environmental Determination:
_ Categorical Exemption-CEOA#
State Clearinghouse No.:
Negative Declaration
Mitigated Negative Declaration
Subject to Fish 8 Game:
Environmental Impact Report .
Gen. Rule Ex. -CEOA #15061.(b)(3)
Other
S.
Staff Report:
Project Video:
9.
Clearinghouse circulation required: Yes
No Date Sent to SCH:
10:
Publication Notice Written:
Display Ad Prepared:
11.
Notices Mailed:
Number of Notices:
12
Nevrapaper Publication Date:
O C P G B R
13.
Planning Commission Hearing(s):
Action taken:
Special Conditions:
Commission Resolution No.
14.
Board of Supervisors' Hearing(s):
Action taken:
Board Resolution No.:
Ordinance No.: Adopted:
15.
Type Use Permit/Send for Signature:
If: i i
16.
N.O.EJN.O.DJAPPENDIX G:
Fish & Game Fees Paid: Yes No
17.
Send Use �,
1998
validated Permit: e>
18.
Assessor's Memo:
19.
Copy of Use PermlWariance to Planning Technician:_ .la 1996
EPARTME* OF DEVELOPMENT SERVICES
BUTTE COUNTY UNIFORM APPLICATION
APPLICANT: Agent information to be provided is on other side:
APPLICAITI"S NAME If applicant is different from owner an affidavit is required ASSESSOR'S PARCEL NUMBER:
ADDRESS: CITY. STATE & ZIP CODE. FILENUMBER.::", OXOFFICEUSE)
ZZ: Rl
NAME OF PROPOSED PROJECT (If any) TELEPHONE
(�/', �) 7- 5 �Z - 5
TION OF PROJE9T ( Majorc3pastreets and Address, iian
j y)_
GENERAL INFORMATION REQUIRED
OWNER'S NAME
TELEPHONE
(1,10> 7 el 9-5315
ADDRESS: crry. STATE & 21P COD>
C
41
ZONE
GENERAL PLAN
EXISTING LAND USE
SITE SIZE ( in Square Feet or Acres
r Igi 000
ExisnNG STRUCTURES (in Square Feet)
PROPOSED mucrum (in square Feet)
bcl�
(Check One)
(Check One)
[3 PROPERTY IS OR PROPOSED TO BE SEWERED
E3 PROPERTY IS OR PROPOSED TO BE ON PUBLIC WATER
C1,VROPERTY IS OR PROPOSED TO BE ON SEPTIC
WMOPERTY IS OR PROPOSED TO BE ON WELL WATER
E3 GENERAL PLAN AMENDMENT
C-3 REZONE
1-3 USE PERMIT
[3 MINOR USE PERMIT
E3 VARIANCE
1--3 MINOR VARIANCE
ADMINISTRATIVE PERMIT
[3 DEVELOPMENT AGREEMENT
FULL DESCRIPTION OF
size of parcels.)
APPLICATION REQUESTED
Planning Division
AUG. 1 2 1996
Proville, California
0 TENTATIVE PARCEL MAP
r-3 TENTATIVE SUBDIVISION MAP
[3 WAIVER OF PARCEL MAP
[3 BOUNDARY LINE MODIFICATION
[3 LEGAL LOT DETERMINATION
E3 CERTIFICATE OF MERGER
LO MINING AND RECLAMATION PLAN
E:3 OTHER
j PROJEPROJECTDESCRIPTION
PROJECT (Attach necessary sheets. If this application is fo . r a
division,
Awl- �1,2 12 A '5 X
the number and
5/1/l> .4
OWNER CERTIFICATION
I CERTIFY THAT I AIM PRESENTLY THE LEGAL OWNER OF THE ABOVE DESCRIBED PROPERTY. FURTHER. I ACKNOWLEDGE THE FILING OF
THIS APPLICATION AND CERTIFY THAT ALL OF THE ABOVE INFOPUMATION IS TRUE AND ACCLIUtTE
(if an agent is to be authorized execute an affidavit of authorization and include the a"Tt with this cxion.)
DATE: 91411 / Val SIGNATURE: r j '�
M
AGENT AUTHORIZATION FORM
To Butte County, Department of Development Services;
Phone # ( )
Print Agent None and Phone Number
Mailing Addrcae
is hereby authorized to process this application for
on my property, identified as Butte County Assessors Parcel Numbers:
This authorization allows representation for all applications, hearings, appeals, etc. and to sign all documents
necessary for said processing, but not including document(s) relating to record title interest.
Owner(s) of Record: (Sign and Print Name)
Print Name
Signature
Architect and/or Engineer:
Print Amhitect/Engineer Name and Phone Number
Mailing Address
FOR OFFICE USE ONLY
Verify:
Date received:
Print Name
Signature
Total amount received:
✓ AP Number(s) NIA Legal Description
y- Owners Authorization Zoning requirements
41 Project Description ✓ Copies of plot plan
Taken by 12 G Receipt No. Lssss E.H. LD Plan-SOO.00 CDF
Payment of the currently required Application Fee and/or Deposit (Any unused portion of a deposit) will be returned
upon final action. 7Soo.0D Bbl
Current fee for this application is S as of
Make check payable to "Butte County Treasurer".
ADMINISTRATIVE PERMIT
Temporary Mobile Home
SUBMITTAL REQUIREMENTS
Prior to submitting an Administrative Permit application, it is requested that the. applicant discuss
the application requirements. County procedures, zoning provisions and possible conditions of ,
approval with the Development Services Staff.
.The following items are required to be submitted at the time of application:
1. The completed, signed, Uniform Application and Affidavit. If the application is signed by
an agent for the property owner, and agent authorization form must be submitted along
with the Application. The Application shall not be accepted unless signed by the
owner or legal agent.
2. Three (3) copies of a plot plan drawn to scale. The finished maps shall be folded to 8 '
'/2" x 11 ". The plot plan must include:
* Name and address of Applicant/Owner.
* Property lines and lot dimensions
* Assessor Parcel Number(s) and the street address.
* Dimensioned locations of existing and proposed dwellings and improvements on
the property (including, but not limited to , buildings, driveways, parking areas,
wells, septic tanks and leach fields). Label all items shown on the map.
* North arrow -and scale of drawing.
* All plans must be clear and legible.
3. Applicant is responsible for obtaining required permits_from the Divisions of
Environmental Healthi aznd Building prior to the -placement of the temporary mobile home. -
4. Applicant is,required to provide a surety bond, cash deposit, or timed certificate of deposit
.to ensure the removal of the mobile home at the end of the permitted period. If the
mobile home is removed at the end of the permitted period, the deposit, or surety bond,
shall be returned to the applicant upon verification of the mobile home removal. Theme
ramount`ofthe bond or deposit shall -be $1,50.0 fora single -wide mobile home,_or_$2,000.
for a double -wide mobile home.
5. Payment of the currently req id Application Fee.
Fee Amount $ Date
6YO
Pianhing Division
AUG 12'1996
OrOvillu, Caiwrn►al
•
,
AFFIDAVIT OF RELATIONSHIP FOR A TEMPORARY MOBILE HOME
The Board of Supervisors has found that for the health, safety, and welfare of the people of the County that it has often become necessar-,
for the care of persons who by reason of old age, disease (either mental or physicao, infirmity or other cause, are unable, unassisted, to
properly manage and take care of themselves, or would benefit from familial assistance to allow mobile homes to be placed on smaller
parcels than present County Codes or Ordinances permit, so that such persons will not have to be institutionalist, but rather can'reside
near their close relatives who can help care for them. The ability to care for one's close relatives will not only result in better care for
citizens, but will also negate in many situations the necessity for public assistance which many citizens find degrading and damaging to
the pride of the persons concerned and their immediate relatives. This will also provide privacy and dignity for the relative as well as
independence, of which these people are deserving.
Please state the circumstances that apply:
�e ro o m
2. Please state the nature of the relationship between the resident(s) of the existing dwelling and the residenttobile
s) of p p r�A
home: (describe relationship by blood or marriage. In cases involving close friends, describe nature of friendship, number of years
known, etc.)
n 0 Ic
� r
3. • old of existing dwelling on the property:�,�1 s•
7�:�_: aft _
Address
4. ResidJelnt(s))oof mobile home proposed to be temporarily placed on the
property:
Name e—c, Name CPIT'- 0(_2 1
Address
5.
Phone # V/4a l � J-5
Number of persons residing in existing dwelling: 3 in proposed temporary mobile 3
We the undersigned state that no rent will be charged to the occupant(s) of the mobile home by the owner or occupants of the real property. In the
event the request Administrative Permit is granted, we also agree to and do herby give the County of Butte, its officers, agents, and employees, arigh
to enter upon said real property and to remove the mobile home from the property and to store same at our sole cost and expense in the event the
mobile home is not removed from the property within one -hundred twenty (120) days of the expiration of the Administrative Permit pursuant to
Butte County Code Section 24-29
We declare under penalty of perjury that the above is true and correct.
r a California
Executed on the day of Li 19_ at
Iro Art le. T 40(p
v ',44
ead of Household of existing dwelling Head of Household of proposed temporary mobile home
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District o&) V i L-
Building Department No.
A. P. Number Nky -0 Siurisdiction:: 0 City
Property Owner 4e9 7W'-[kSE--7CK
County
Planning Division
AUG 1 2 9996
Orovii1e, Californias
Property Location/Address C 73- /,n �2 4- F Ra !.J
Subdivison Lot No.
Residential Development
No. of Living MHI Addition
Units !z JPL Area
Sq. Footage 6 v2 4 —
(Group R)
L-iSO '?'' SEE, -,47 T7k-YAJ
Commercial/Industrial Sq. Footage
f New Addition (Including Exterior
Roo fe Areas)
Building DepartrrierA Representative Date - -
District Identification No.
r gNAO ,1.1 a)nLL
t. (Floor Plans reviewed by School District Personnel)
9700.3
School District
that �tU�
vtbk
Applicant)
)1- 5�% 4, � 0 - IWC
(Street Address) V
(Phone Number)
(City) v (State) (Zip Code)
has complied with the requirements of Resolution No. ` by payment of $
representingn square feet.
n
School
Paid by Check# Remarks:
Bank Number
Paid by Cash SN
AB 2926 $
FULL MITIGATION $ 1 II
Date
M
If, subsequent to the School igtact Representative signing this Butte County Schools Impact Fee
Certification Form, the School istrict is notified by.the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feeform.wkt (11/94)dmm
Inter -Departmental Memorandum
TO: Auditor's Office, •1?cehf 111�
From: Planning Division,Teri Bridenhagen
Subject: Return of deposit on APN 028-050-023'-,
Date: October 8, 1998
In September 1996 on ATR #74867, $750.00 and in April 1997 on ATR#79390, $400.00 and
ATR #79428, $350.00 was submitted to your office for deposit for the above -referenced project:
It was deposited in fund code 1001, account code 280, cash code 1011305. See attatched ATR
copies.
Please return the deposit and interest earned to the applicant. The temporary mobile home has
been removed so the permit is no longer needed. Make the check payable to Dorothy Keck,
1273 Middle Honcut Rd., Oroville, CA 95966.
Brian Larsen
Principal Analyst
Inter -Departmental Memorandum
TO: Auditor's Office, Robin
From: Planning Division,Teri Bridenhagen
Subject: Return of deposit on APN 028-050-023
Date: October 8, 1998
'�r'rt_i4l�
In September 1996 on ATR #74867, $750.00 and in April 1997 on ATR#79390, $400.00 and
ATR #79428, $350.00 was submitted to your office for deposit for the above -referenced project.
It was deposited in fund code 1001, account code 280, cash code 1011305. See attatched ATR
copies.
Please return the deposit and interest earned to the applicant. The temporary mobile home has
been removed so the permit is no longer needed. Make the check payable to Dorothy Keck,
1273 Middle Honcut Rd., Oroville, CA 95966.
Brian Larsen
Principal Analyst
�V4*-"
Planning Division
NOV 0 4 1998
Or®viii®, Gaiifornia
Pianning Dit►ision
5�P-2 2199 -
_ ®roville, California
•
A-5
Middle Honcut Road
A-5
ADM 97-01
AP#028-050-023
Dorothy Keck
Project Location
st
A-5
1
July 1, 1998
Dorothy Keck
1273 Middle Honcut Rd.
Oroville, CA 95966
Re: Temporary Second Dwelling
AP 028-050-023
Dear Ms. Keck:
LAND OF NATURAL WEALTH AND BEAUTY
PLANNING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE • OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (530) 538-7601
FAX: (530) 538-7785
On September 3, 1996, the Butte County Director of Development Services approved your permit
for a temporary second living unit on your property. Section 24-304, as amended, of the Butte
County Code provides that your permit shall be only for a term of one year, and must be renewed
annually if the use is to continue.
Effective July 12, 1993, the Butte County Board of Supervisors adopted an annual renewal fee of
$50.00 for temporary second dwellings.
Inasmuch as your renewal expires on September 3, 1998, you are hereby advised to apply for a
renewal. Please complete the enclosed renewal form and return it to this office with your check in
the amount of $50.00 made payable to the Butte County Treasurer.
Should you have any questions regarding this matter, please contact this office.
Sincerely,
Thomas A. Parilo
Director of Development Services
`J
Teri Bridenhagen
Office Assistant III
J:\temp\tempi
Date 09/10/96 fivart
elo ment Services De mqnt
P P
Time 3:12 pm Applicant Billing Worksheet
ADM 97-01 * Dorothy Keck
1273 Middle Honcut Road
.Oroville, CA 95966
In reference to : Administrative Permit, AP#028-050-023
Rounding : None
Full Precision : No
Last bill / / Last aging
Last charge 09/05/96
Last payment / / Amount $0:00
Date/Slip#
Description
HOURSIRATE
AMOUNT
08/12/96
Larry / P
0.50
29.50
#9553
Processing
59.00
08/12/96
Paula A. / C
0.50
17.00
#9579
Clerical
34.00
08/12/96
Linda / C
0.50
17.00
#9600
Clerical
34.00
08/26/96
Paula A. / C
0.50
17.00
#9771
Clerical
34.00
TOTAL BILLABLE TIME CHARGES
2.00
TOTAL BILLABLE COSTS
TOTAL NEW CHARGES
PAYMENTS/REFUNDSICREDITS
08/12/96 Deposit - Receipt #15555
TOTAL PAYMENTS/REFUNDS/CREDITS
NEW BALANCE
New Current period
TOTAL NEW BALANCE
(300.00)
(219.50)
Page 1
TOTAL
$80.50
$0.00
$80.50
($300.00)
($219.50)
SENDER:
o
to Complete items 1 and/or 2 for additional services. I also wish to receive
y • Complete items 3, and 4a & b. following services (for an V
• Print your name and address on the reverse of this form so that we can fee): >
> return this card to you.
• Attach this form to the front of the mailpiece, or on the back if space 1. ❑Addressee's Address d
rA
does not permit. r,
t • Write "Return Receipt Requested" on the mailpiece below the article number. 2 ❑ Restricted Delivery G
• The Return Receipt will show to whom the article was delivered and the date V
o delivered. Consult postmaster for fee. d
3. Article'Addressed to: 4a. Article Nurntgr
��or clL D�
E (�� "- 4b. Service Type
►—`''• ElReeisRegistered ❑Insured
QRO V ll,l.�to
Certified ❑ COD E
W 1 El Mail ❑Return Receipt for
p� Merchandise
O 7. Da of Deli _very
DZ�•Q50-Oz3D�u.�i7� I
cc 5. Signature (Addressee) 8. Addressee's Addre s (Only if requested Y
and fee is paid)
LU
H t
ec f Autw (Agent) _
o—
orm 381 , December 199 *U.S. GPO: 188223-402 DOMESTIC RETURN REC T
N
U D STATES POSTAL SERVICE
Official Business
PENALTY FOR PRIVATE
USE TO AVOID PAYMENT
OF POSTAGE, $300
Print your name, address and ZIP Code here
COUNTY OF BUTTE
DEPARTMENT OF DEVELOPMENT SERVICES
PLANNING DIVISION
. 7 County Center Drive
Oroville, CA 95965-3397
Z . 379 '332, 05❑
Receipt for
Certified Mail
No Insurance Coverage Provided
Do not use for International Mail
WDTED STATES
September 3, 1996
Dorothy Keck
1273 Middle Honcut Rd.
Oroville, CA 95965
PLANNING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (916) 538-7601
FAX: (916) 538-7785
CERTIFIED MAIL
Re: Administrative Permit, AP 028-050-023
Dear Ms. Keck:
Enclosed is your validated Administrative Permit No. ADM. 97-01 to allow for a temporary
second dwelling to be located at 1273 Middle Honcut Rd., Oroville, on property zoned
ARMH-1 (Agricultural Residential Mobile Home) zone.
Should you have any questions regarding this matter, please contact this office between
8:00 a.m. and 4:00 p.m., Monday through Thursday.
Sincerely,
Fel
Director of Development Services
WF:pa
Enc.
cc: Land Development Division
Building Division
Environmental Health
Department of Forestry
j:\lemp\up7
TO:
FROM:
DATE:
PURPOSE:
E
C]
ADMINISTRATIVE PERMIT for TEMPORARY MOBILE HOME
Dorothy Keck
William Farrel, Director of Development Services
August 19, 1996 FILE: ADM 97-01
Administrative Permit on AP#028-050-023 for a temporary second dwelling to be
located at 1273 Middle Honcut Road, Oroville, in the ARMH-1 (Agricultural
Residential Mobile Home) zone.
PERMIT REQUIREMENTS: Approval for a temporary second dwelling is subject to the.following
requirements.
1. Occupancy of the mobile home shall be limited to Bill Keck. An affidavit attesting to the
relationship of,the involved parties was submitted with the permit application.
2. No rent is to be charged to the occupant of the mobile home.
3. The temporary mobile must meet the requirements of the Butte County Environmental Health
Department for domestic water supply and sewage disposal. The granting of this permit does
not remove the requirement of obtaining the appropriate permits from other Divisions,
Departments or Districts.
4. The siting of the- mobile home shall be exempt from the site requirements of the residential
zoning district, except as required by this'Section, and the Butte County Code Chapter 28A.
5. The mobile home is declared to be a temporary use on the property, accessory to the primary
unit, and shall not be placed on a permanent foundation. Additionally, a temporary mobile
home shall not be permitted on a lot or parcel where there is an approved Second Unit.
6. The permit shall be granted for a term of two years. Extensions of the term for the permit, not
exceeding one year for each extension, may be granted if the application for the extension is
filed, with the Planning Division, within 60 calendar days prior to the date of expiration.
7. The mobile home shall be vacated upon expiration, or revocation, of the Permit and removed
within one hundred twenty (120) days after expiration of the Permit. If it is not removed within
one hundred twenty (120) days, the County shall remove said mobile home and store it at the
owner's expense.
8. The Permit may be revoked if any of the terms or conditions of the Permit are violated or if any
acts or omissions of the permittee in connection with the use authorized by said Permit
constitute a public nuisance.
9. The applicant must maintain a bond or deposit in the amount of $1,500 for a single -wide
mobile home or $2,000 for a double -wide mobile home.
Permittee Signature Date Will'v. arrel. Director Dev. Services Date
APPROVED
1Development Plan
4Zz RITE So--.3.�99f�
USE PERMIT _..VARIANCE //._..
V -TNOR U.P.,,,.,..,_ADM.PERM►T
PLANNING COMMISS.
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Planning Division
AUG 12 1996
OrovzIle, Calitomia,
ti
03VONqqA
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OEM— AIRAV.,. TJNIR34 32111
221IMMOO OV.114MAJq
R30AAAMI
•
MEMORANDUM
TO: Butte County Assessor's Office
FROM: Butte County Planning Department
SUBJECT: Dorothy Keck
DATE: September 3, 1996
Pursuant to Section 65863.5 of the Government Code, the following parcel identified as
028-050-023, was:
Rezone from to zoning district.
Granted a variance to
X Issued a conditional Administrative permit for a temporary second dwelling
to be located at 1273 Middle Honcut Rd., Oroville, on property zoned ARMH-
1 (Agricultural Residential Mobile Home).
j Atemp\assessor
OFFICIAL RECEIPT
COUNTY OF BUTTE
STATE OF CALIFORNIA
OFFICE OF PLANNING
RECEIPT 15852
I
Is ED BV
5
7.
Z,
,4'-2P
RECEIPT TOTAL
PVBLIC
LAFCO
U5E
VARIANCES
PUBLIC
ZONING
ENV
OTNER
APPA CANT
RECEIVED FROM
OAl"E
NO. RECEIV EO
WORN$
PERMITS
DOCUMENTS
MEALTR
OFFICIAL RECEIPT
COUNTY OF BUTTE
STATE OF CALIFORNIA
OFFICE OF PLANNING
RECEIPT 15852
I
Is ED BV
5
77 77
.vCO
DATE RECEIPT TOTALPUBLIC
NO. RECEIVED WORHS LAFCO USE VARIANCES PUBLIC ZONING ENV
PERMITS DOTS OTHER
CUMEN
HEALTH
I•_�l.l—C.w� "'� �� �^—�'r O`er'
1
OFFICIAL RECEIPT
COUNTY OF BUTTE
STATE OF CALIFORNIA
OFFICE OF PLANNING
roc c X yi
'P ICANT RECEIVED FROM
RECEIPT 15820
Issu D By
3
-
!.
':.
.'•• ...
'.
., ..
.. °.
.'�. �.
RECEIPT
,•
'DATE
NO.
TOTAL,
PU PUBLIC C
LAFCO
VSE
PU BIIC
RECEIVED
WORKS
PeRmlrs
VARIANCES
Docum ears
ZONING
ENV
weALrN
orNew
APPLICANT
RECEIVED FROM
RECEIPT 15846
OFFICIAL RECEIPT
COUNTY OF BUTTE
STATE OF CALIFORNIA
OFFICE OF PLANNING
MEMORANDUM
TO: Dorothy Keck AP # 028-050-023
FROM: Development Services/Planning Division
SUBJECT:' BOND FOR TEMPORARY MOBILE HOME
DATE: September 3, 1996
Dorothy Keck is being given six months to meet the bond requirements of the Administrative Permit
for a Temporary Mobile Home. It is agreed that she will pay half ($750.00) of the $1,500.00 on or
before September 4, 1996 with the other half ($750.00) to be paid on or before Aprila;997.
Failure to complete payment by the agreed upon date would be a violation of the Permit
Requirements for a Temporary Mobile Home, and would be cause for revocation of the permit.
orothy Keck
JAMEMOM
Ar Butte County AF Department of Development Services z Director's Office Ar
I
16
A .4-MiS&LANEOUS (All others)
AMWEST suarav comma Q mom
BOND APPLICATION
4
Name (Must be exactlyas 't is to appear on bond)
❑ Partnership ❑ Corporation
Social Security No. or T x I.D.
rO x
mole Proprietorship
�� �'j��p - 8 Zz
Address — Street City
1� r A `�
Zip'
Phone
?/,
jai any �
G,59G 6:
Zip
Bond mount
-
ffec ' e Date
Employment
Previously bond d
Date BUSsS Started
1111119
Type of Bond
AttacA bond form and any other pertinent information
Spouse's Name
-(2, ,
Obligee jvyho is reel ng bon
St t Cit p
t
Name: �l LL ( Address:
� (; j' 5
Nearest living re idin a ame dress: N me
e ol o C�1 � t
Address
f /e /�
-Phone elationship
BANKING I ATION
p
Name:
Telephone #:
Address:
Account #(s):
Names of ALL OWNERS of business
1. 2.
3.
Title
Title Title
Do you, or any owner, own any real property? If yes,
Address / / (, Value Amt. o ing r' Purchase Price Purchases D�e
1. ' tG(CaF /- %C.l J , 1 (e, O 1,57600 �t0
Address Value
Amt. owing Purchase rice Purchase Date
2.
INDEMNIFICATION AGREEMENT — READ CAREFULLY AND SIGN
The maker or makers of the foregoing statement hereby authorizes the company to investigate my statements and to check my credit with any creditors or lending institutions. The undersigned
and each of them hereby certify that each statement herein contained is true and that this statement and/or answers to the questions is made for the purpose of inducing the Amwest Surety
Insurance Company to execute or continue certain bonds or undertakings. In consideration of the execution of this bond by the Amwest Surety Insurance Company (hereinafter called Surety), the
undersigned (Applicant) hereby agrees
1. To pay to Surety upon demand:
a. The premium or premiums determined by the Surety on said bonds.
b. A sum of money to cover any liability, claim, suit or judgment against said bond, and any legal fees or expense incurred thereon.
C. To indemnify the Surety and hold harmless the Surety from any and all liability, damages, loss, costs and expenses of every kind and nature including attorneys' fees which the Surety
may sustain or incur in consequence of having executed said bond or enforcing the terms of this agreement against any of the undersigned, or in procuring or attempting to procure its
release from liability under said bond.
2. Surety shall have the exclusive right to determine whether any claim or suit shall, on the basis of liability, expediency or otherwise, be paid, compromised, defended or appealed.
3. An itemized statement of loss and expense incurred by the Surety, sworn to by an officer of the Surety, shall be prima facia evidence of the fact and extent of my obligation to the Surety.
4. Surety may procure its release from said suretyship under any law for release of sureties without liability to me for any damages I sustain therefrom.
5. This agreement shall apply to all renewals, continuations, substitutions and extensions of the suretyship herein applied for.
6. Surely is authorized to complete any blanks contained in the application or Indemnity agreement at the time of execution by the undersigned.
7. It is understood and agreed that the premium for this bond is fully earned upon issuance and is not refundable In the first year of coverage.
8. If cancellable, Surety may cancel this bond for cause and not return any part of said premium. Cause shall include, but not be limited to: Failure to comply with the terms of the Indemnity
Agreement or any agreements between the parties; Furnishing of incorrect information to Surety; Failure to make payments into any Build -Up Fund called for; Decrease in security, if any,
given to Surety; Any claim(s) upon the bond; Obtaining the bond through misrepresentations, whether intentional or negligent; Failure to furnish information when requested by SURETY:
Aiding or abetting another in the presentation of a false or fraudulent claim(s); Failure to make any payment demanded by SURETY pursuant to this Agreement.
9. COLLATERAL SECURITY — If a claim is made against Surety, or if Surety deems it necessary to establish a reserve for potential claims, and upon demand from Surety, the Undersigned shall
deposit with Surety cash or other property acceptable to Surety, as collateral security, in sufficient amount to protect the Surety with respect to such claim or potential claims and any ex.
pense or attorneys' fees. Such collateral may be held by Surety until it has received evidence of its complete discharge from such claim or potential claims, and until it has been fully reim-
bursed for all loss, expense and attorneys' fees.
IMPORTANT -
If sole owner, applicant must sign on behalf of firm, applicant and spouse
must sign personal indemnity below.
If partnership, all partners must sign on behalf of firm. All partners and
spouses must sign personal indemnity below.
If corporation, two authorized officers must sign. All stockholders and spouses.
must sign indemnity below.
Signed and dated this day of -AqUS A.D. 19
SIGNAT E OF P LICAANJT FOR BOND:
ro C4
/) (Fir Name
x �J
X- — ------ - - - - -
(Please int/ty name under signature)
(Witness) x
In consideration of the execution by the Amwest Surety Insurance Company of the suretyship herein applied for, each of the undersigned, jointly and severally, agrees to be bound by all
of the terms of the foregoing indemnity agreement executed by the applicant, as fully as though each of the undersigned were the sole applicant named herein, and admit to being financially in.
terested in the performance of the obligation which the suretyship applied for is given to secure.
N
Residence
SIGNATURE OF PERSONAL INDEMNITORS
(Phone
No.
City / / Zip
Place of Phone
Employment��/� k o � No. !j /J
Driver's License ll rL-1JS(? / /(a Soc. Sec. # :flag -4 _3/ 2
Additional indemnitors sign on reverse.
UN -A7005 2/90 n
X
Signature
X
Name printed or typed
Residence
Phone
Address:
No.
City
Zip
Place of
Phone
Employment
No.
Driver's License If Soc. Sec. #
Continued on reverse side — Please read completely before signing
t
Continued from reverse side — Please read c tely before signing
X
Signature
X
Name printed or typed
X
Signature
X
Name printed or typed
Residence - Phoneo • ". . •
Residence
Phone
Address: No.
Address:
No.
City Zip ` ' A
City
Zip
Place of Phone
I
Place of
Phone
Employment 1S No.
Employment
Mv �7 �
Driver's License q / soc. Sec. N
Driver's License p
Soc. Sec. #
FINANCIAL STATEMENT
AMWEST
1) BUSINESS FINANCIAL STATEMENT
gumv 9flWY@fl@@ QqRo@rly
FINANCIAL STATEMENT: Attach accountant's or bank's statement form, including Profit & Loss Statement. If none available, complete below
Nome of Firm Statement of Financial Condition as of
(Date)
ASSETS DOLLARS Cents LIABILITIES DOLLARS Cents
Cash on Hand "c Accounts Payable
Cash in Bank Name and address of bank Notes Payable — Unsecured:
ACCOUNT NUMBER: Banks
Accounts Receivable Partners or officers
Notes Receivable Other
Other Describe Notes Payable — Secured:
Owing to
Taxes Payable or Accrued
Accrued Payroll and other expenses
TOTAL CURRENT ASSETS
Land and Buildings (Depreciated Value) a0
Machinery, Fixtures and Equipment
Depreciated Values TOTAL CURRENT LIABILITIES
Due from Others — Not Current Describe Liens or Chattel Mortgages on Equipment
Mortgages on Real Estate
Other Liabilities (Describe)
Other Assets (Describe) TOTAL LIABILITIES
Net Worth Capital $
Surplus $
TOTAL ASSETS '0O OD TOTAL LIABILITIES AND NET WORTH
Gross Sales for Period from to : $ Net profit $
PROD
Name:
Addres
City &:
MAIL COMPLETED AND SIGNED APPLICATION WITH NET CHECK TO:
WX Amwest
Phone: (%�l0 ) 7700
If new produc
_Tax I.D. no.: 7^�
License no.:
Amwest Producer no.
AMWEST SURE* INSURANCE COMPANY
WOODLAND HILLS, CALIFORNIA
To induce COMPANY to become surety for the Undersigned, or to accept
the Undersigned as Indemnitor, the Undersigned submits the following Financial Statement
PERSONAL FINANCIAL STATEMENT
NOTE: This form to be used for Personal Financial Statements only. NOT TO BE USED FOR BUSINESS STATEMENTS.
Personal financial statement of
S.S. NO.
(Name)
J-4
(Street Add41ss,'City,J)' State, Zip) HOME PHONE NO. BUS. PHONE NO.
NAME OF VVIFVHUSBAND
AS OF 9 // -' —_ , 19 05Z,
I (Date)
/V -
CURRENT ASSETS
CURRENT LIABILITIES
Cash on hand (not in bank) ....................
Cash in following banks (names and addresses)-
ni rvic— r j.C.,O .............
............................................
Stocks and bonds (Schedule 1) .................
Accounts receivable (Schedule 2) ...............
Notes receivable (Schedule 3) ..................
Other current assets (itemize):
............................................
............................................
............................................
.............................................
./ S
Notes payable to (names and addresses):
.............
...........................
L4,1_1 ..................................
Sales Contracts & Chattel Mtgs. (Sch. 6) .........
Accounts payable..............................
Current portion of long term debt ...............
Other current liabilities (Schedule 6) ............
............................................
Current Year's Income Taxes Unpaid .............
Prior Year's Income Taxes Unpaid
Real Estate Taxes Unpaid . ...............
117y
—
TOTAL CURRENT ASSETS
I
TOTAL CURRENT LIABILITIES
FIXED ASSETS
LONG TERM LIABILITIES
Real estate (Schedule 4):
Residence ...............................
Other.............................
Cash value of life insurance (Schedule 5) ........
Other assets and investments (Schedule 6) ......
.............................................
.............................................
............................................
............................................
............................................
_75,6o0
Real estate debt (Schedule 4):
Residence ...............................
Other ....................................
Borrowed on life insurance (Schedule 5) .........
Other long term debt (Schedule 6) ..............
............................................
..............................................
............................................
............................................
.
.
44
TOTAL LONG TERM LIABILITIES
TOTAL FIXED ASSETS
NET WORTH
TOTAL ASSETSV7,
�O
I TOTAL LIABILITIES AND NET WORTH
CONTINGENT LIABILITIES
FOR ENDORSEMENT'S OR GUARANTEES $ FOR OTHER PURPOSES $
GIVE DETAILS
(Rev. 7186)
1: -STOCKS -AND' BONDS
No. Ii�pledged, State to Whom Dividends Paid
Name of Security Shares and for Wh urpose Last Two Years u Market Value Book Value
TOTALS $ $
2. ACCOUNTS RECEIVABLE
Name and Address (street and city) From Whom Due ( For What is it Due When Sod Duen Amount
TOTAL $
3. NOTES RECEIVABLE
Name and Address (street and city) From Whom Due For W at Due How Secured Date Maturity Amount
TOTAL 11 $
4. REAL ESTATE
Description of Property Title in Market Value Cost Date Amount Monthly Monthly
Name Of Acquired Encumbrance Payments Income
O I
TOTALS $ Is Is Is
5. LIFE INSURANCE
— CASH VALUE
Name of Company Policy Number Name of Insured
Beneficiary Face Value Cash Value Amount Borrowed
SCHEDULE 6 DETAILS RELATIVE TO OTHER IMPORTANT ASSETS AND LIABILITIES
Authority is hereby granted to any individual, firm or corporation, and any financial institution to furnish Amwest Surety Insurance Company upon its request
with any information concerning the above statement or pertaining to the Undersigned's financial standing, credit or manner of meeting obligations.
SIGNED AND SEALED THIS J ��� DAY OF
1996
SENDER:- t
oI
y • Complete items'1 and/or 2 for additional services.
also wish to receivt
d • Complete items 3, and 4a & b.
following services (for an
V
` • Print your name and address on the reverse of this form so that we can
feel:
>
Q) return this card to you.
y • Attach this form to the front of the mailpiece, or on the back if space
1. ❑ Addressee's Address
y
`' does not permit.
L• Write "Return Receipt Requested" on the mailpiece below the article number.
2 ❑ Restricted Delivery
�
S•
The Return Receipt will show to whom the article was delivered and the date
o delivered.
Consult postmaster for fee.
V
3. Article Addressed to:
koro lLe K
4a. Article Number ' /
Db. `� 3
fr
CL fn
4z3 �79 ice y33Z
pe
O / >'73 ir/
❑ Registered El Insured
14.1
N 1-71 59��
W o�iGLQ 9,
ertified ❑COD
❑ Express Mail ❑ Return Receipt for
p
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0
O 7. Dato r
Signature (Addressee) 8. Add ssee's c
U*3 _ ,. -ell / / and fee is D ' dl
irk 6. SiCrr'
3
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.rchandlse `o
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(Only if requested Y
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m
L
H
, December 1991 *U.S. GPO: 1992--323-4W DOMESTIC RETURN RECEIPT
*D STATES POSTAL SERVICE
Official Business
PENALTY FOR PRIVATE
USE TO AVOID PAYMENT
OF POSTAGE, $300
U.S. MAIL
Print your name, address and ZIP Code here
COM OF BUTTE
DEPARTMENT Of DEYEtAPMENi SUNM
PLANNING DIVISION
Z. 379. 332 043.
Receipt for
Certified Mail
No Insurance Coverage Provided
urarED STATES Do not use for International Mail
�OSr4 SERVCE
(See Reverse)
M Stritvo
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cc
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Street and No.
IZ77
Pte. tate' � d ZJP ode
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CTS
Postage
Certified Fee
Speciat. DeliVerviFee.
F#6 st f fe t edi Det iverpj Fee:
Return Receipt Showing
to Whom & Date Delivered
Return Receipt Showing to Whom,
Date, and Addressee's Address
TOTAL Postage
1
& Fees
Postmark or Date
AUG 2 2
1996
August 20, 1996
Dorothy Keck
1273 Middle Honcut Rd.
Oroville, CA 95966
CERTIFIED MAIL
Re: Administrative Permit, AP 028-050-023
Dear Ms. Keck:
71
PLANNING DIVISION
DEPARTMENT OF DEVELOPMENT SERVICES
7 COUNTY CENTER DRIVE - OROVILLE, CALIFORNIA 95965-3397
TELEPHONE: (916) 538-7601
FAX: (916) 538.7785
Enclosed are the original and one copy of your conditional Administrative Permit No. ADM
97-01. Please sign and return both copies to this division within 30 calendar days from the
receipt of this letter. We will then have them validated by the Director of Development
Services and the original will be returned to you for your records.
Please be aware that failure to return the signed copies within 30 days will result in the
Administrative Permit becoming invalid. Re-application to this department would then be
necessary to proceed with the project.
The Administrative Permit is deemed granted when this permit has been signed by the
applicant, with the counter signature of the Director of Development Services, a bond or
deposit is made, and said permit is received by the applicant by Certified mail.
Should you have any questions regarding this matter, please contact this office between
8:00 a.m. and 4:00 p.m., Monday through Thursday.
Sincerely, r
m Farrel
:or of Development Services
WF:pa
Enc.
jAemp\up6A
LEAD - IN SHEET
FILE NO: ADM 97-01 AP# 028-050-023
APPLICANT: Dorothy Keck, 1273 Middle Honcut Rd., Oroville 95966'
Name Address
OWNER: same
Name Address
REPRESENTATIVE: None
Name Address
REQUEST: Administrative Permit:
SIZE:
LOCATION:
SUPERVISORAL DISTRICT # EXISTING ZONING:
ZONING HISTORY:
SURROUNDING ZONING:
SURROUNDING LAND USE:
SITE HISTORY:
GENERAL PLAN DESIGNATION:
APPLICABLE REGULATIONS:
kAforms\lead-in
0 0
COMAHNT DISTRIBUTION LIST
APPLICATION: DnrnthWKarkr Administrative Permit File #ADM 97-01
DATE: 08-12-96
County Offices and Cities:
Chief Administrativeffi, _X_ evelop._Secvic s-Directo _X_ Public Works Director
Environmental Heal _ Building Manager
131. Sheriff — BAG — ALUC
X'. CF ZAPCD _ Butte Co. Farm Bureau
Biggs — Gridley _ Chico
Oroville _ Paradise _ Chico Airport Commission
Agricultural Commission
anon DisMct:
— Butte Water — iggslW. Gridley W2
_ Paradise Lrigation
Tab ountain Irrigation — Thermalito Irrigation
Domestic Water
Butte
OWID
Butte Water District
Skansen Subdivision
California Department
Recreation Districts
— Chico 9c�ecreati/-
'_ Durham Irrigation
Richvale Irrigation
Other
Service Co._ Del Oro Water Co.
tion District Other
Themalito Irrigation/ — Gerling City Sewer Main
L.O.A. PUD 11 1
of orestry — EI Medio Fire Protection District
n
_
Du rh Area Recreation — Feather River Rec. & Park
Park Richva Recreation & Parks
7taities
PG&E No
- hico _
Ch ers Cable —
Pacific Bell
_
PG&E Sou
- oville
Vi in Cable TV
State Agencies
CalTrans
Dept of Water Resources —
ept of Fish and Game
_ —
— Forestry : Craig Carter) _
Dept of Parks and Rec. —
way Patrol
Central eg. Water Quality Control
_
— Dep ent of Conservation —
Off. of Mining Reclamation
Off. o overnmental & Env. Relations
Federal Agenci
US orest Service
US Bu u of Land anagement
—
Other Districts, Agencles, ommittees, eta
gime Saddle Dist
Community Association —
Mosq. atement Oroville/Butte Co
_
Drainage
Butte Env.1 Council
Paradise ines Com.
Reclamation _
Cal Native Plant Society —
_
Butte Co. Mining Co —
—
$ ��..910
ISSSS
3O°-
300-
�
.. rn
C%Jv
��a{in Keck
carne
RECEIPT
TOTAL
PUBLIC
LAFCO
USE
VARIANCES
PUBLIC
ZONING
ENV
OTHER'
APPLICANT
RECEIVED FROM
DATE
NO.
RECEIVED
WORKS
PERMITS
DOCUMENTS
HEALTH
RECEIPT 15555
OFFICIAL RECEIPT
COUNTY OF BUTTE
STATE OF CALIFORNIA
OFFICE OF PLANNING
ISSUED BY
0
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•
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Planning Division
AUG 12 1996
Omville, Caiifomia
ZONA IN c, 0 Vv, f
HONPUT* T. 17 N. R.-4 L. M. D. B. Ek M.. 26-Q5
Tax Area Code -92- 13
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Assessor's Map No.28-05
NOTE—ASSESSOR'S PARCEL BLOCK County of Butte, Calif
& LOT NUMBERS SHOWN M,4R 1951
IN CIRCLES
128
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NOTE—ASSESSOR'S PARCEL BLOCK County of Butte, Calif
& LOT NUMBERS SHOWN M,4R 1951
IN CIRCLES
128
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NOTE—ASSESSOR'S PARCEL BLOCK County of Butte, Calif
& LOT NUMBERS SHOWN M,4R 1951
IN CIRCLES
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