HomeMy WebLinkAboutLLA20-0010_Project_Information_FormButte County Department of Development Services TIM SNELLINGS, DIRECTOR I PETE CALARCO, ASSISTANT DlRECTOR 7 County Center Drive Oroville, CA 95965530. 552.370 I Telephone530.538.7785 Facsimile
PROJECT INFORMATION Project# (Staff Use Only)
APPLICANT'�AME: (If applicant is different from owner an affidavit is required.) ASSESSOR'S PARCEL NUMBER: {9 c d 2 c;; ( I c t,°)l-A-<--1..>0 3 ? -0 o -CJADDRESS: STREET, CITY, STATE, & ZIP CODE //f(C cJ TE�mri::.
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( ) OWNER'S N TELEPHONE:
ADDRESS: STREET, CITY, STATE, & ZIP CODE: � m£
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PROPERTY INFORMATION SITE SIZE (in square feet or acres) D A-c...
LA-N £ --<? t+rc o PROPOSED LAND USE ' G-UNDER WILLIAMSON ACT CONTRACT D Yes · o(Check One) � 1 j D PROPERTY IS OR PROPOSED TO BE SEW ERE N; Ii 0 PROPERTY JS OR PROPOSED TO BE ON SEPTIC 01<.CII f
(Check One) 0 PROPERTY IS OR PROPOSED TO BE ON PUBLIC WATER )sl_ PROPERTY IS OR PROPOSED TO BE ON WELL WATER
0 ADMINISTRA TTVE PERMIT 0 LEGAL LOT DETERMINATION 0 CONDITIONAL USE PERMlT D MINOR USE PERM.IT
APPLICATION TYPE 0 TENTATIVE SUBDIVISION MAP 0 TENTATIVE PARCEL MAP D w AIYER OF p ARCEL MAP 0 CERTIFICATE OF CORRECTION 0 COMMUNICATIONS FACILITY UP/MUP D VARIANCE 0REZONE 0 GENERAL PLAN AMENDMENT D MINOR VARIAiC� �OT LINE:OJ ST� 0 CERTIFICATE OF MERGER
0 MINING AND RECLAMA T!ON PLAN 0 DEVELOPMENT AGREEMENT
DoTHER
PROJECT DESCRIPTION FULL DESCRIPTION OF PROPOSED PROJECT (Attach necessary sheets. lfthis application is for a land division, describe the number and size ofparcels.) Pr:>. OT£C{ )£'£.,t<5 To A-n22 & ot, A-c /D
OWNER CERTIFICATION
I CERTIFY THAT I AM PRESENTLY THE LEGAL OWNER OR THE AUTHORIZED AGENT OF THE OWNER OF THE ABOVE DESCRIBED PROPERTY. FURTHER, I ACKNOWLEDGE THE FILING OF THIS APPLICATION AND CERTIFY THAT ALL OF THE ABOVE INFORMATION IS TRUE AND
A CCU RA TE. (If an agent is to be authorized, execute an affidavit of authori tion and include the affidavit with this application.)
DATE: _</._-_8_--=Z---'Q'--,Z;,,..._D __ SIGNATURE: �����'--L."72_�·_:,/\/;_�'......!����.A::::::::::.=-----
Please contact Plannin Division Staff with an uestions.
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