HomeMy WebLinkAboutTSM21-0001 APPLICATION 2020-01-05Butte County Department of Development Services
TIM SNELLINGS, DIRECTOR | PETE CALARCO, ASSISTANT DIRECTOR
7 County Center Drive
Oroville, CA 95965
530.55 2 . 3701 Telephone
530.538.7785 Facsimile
PROJECT INFORMATION
APPLICANT’S NAME: (If applicant is different from owner an affidavit is required.) ASSESSOR’S PARCEL NUMBER: - -
ADDRESS: STREET, CITY, STATE, & ZIP CODE TELEPHONE:
( ) -
E-MAIL:FAX:
( ) -
OWNER’S NAME: TELEPHONE:
( ) -
ADDRESS: STREET, CITY, STATE, & ZIP CODE:
PROPERTY INFORMATION
NAME OF PROPOSED PROJECT (if any) SITE SIZE (in square feet or acres)
LOCATION OF PROJECT (major cross streets and address, if any)
BA
ZONE GENERAL PLAN EXISTING LAND USE PROPOSED LAND USE
EXISTING STRUCTURES (square feet) PROPOSED STRUCTURES ( square feet) UNDER WILLIAMSON ACT CONTRACT Yes No
(Check One)
PROPERTY IS OR PROPOSED TO BE SEWERED
PROPERTY IS OR PROPOSED TO BE ON SEPTIC
(Check One)
PROPERTY IS OR PROPOSED TO BE ON PUBLIC WATER
PROPERTY IS OR PROPOSED TO BE ON WELL WATER
APPLICATION TYPE
ADMINISTRATIVE PERMIT TENTATIVE SUBDIVISION MAP
LEGAL LOT DETERMINATION TENTATIVE PARCEL MAP
CONDITIONAL USE PERMIT WAIVER OF PARCEL MAP
MINOR USE PERMIT CERTIFICATE OF CORRECTION
COMMUNICATIONS FACILITY UP/MUP REZONE
VARIANCE GENERAL PLAN AMENDMENT
MINOR VARIANCE MINING AND RECLAMATION PLAN
LOT LINE ADJUSTMENT DEVELOPMENT AGREEMENT
CERTIFICATE OF MERGER OTHER _____________________________________
PROJECT DESCRIPTION
FULL DESCRIPTION OF PROPOSED PROJECT (Attach necessary sheets. If this application is for a land division, describe the number and size
of parcels.) ________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________
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
ACCURATE. (If an agent is to be authorized, execute an affidavit of authorization and include the affidavit with this application.)
DATE: __________________________ SIGNATURE: _________________________________________________________
AGENT AUTHORIZATION
To Butte County, Department of Development Services:
( ) Print Name of Agent Phone Number
Mailing Address
is hereby authorized to process this application on my/our property, identified as Butte County Assessors Parcel Number(s)
This authorization allows representation for all applications, hearings, appeals, etc. and to sign all documents necessary for said processing, including mitigation and conditions of approval, but not including documents(s) relating to title interest.
Owner(s) of Record (sign and print name)
______________________________________
Print Name
_______________________________________
Print Name
______________________________________ Signature
_______________________________________ Signature
______________________________________
Print Name
_______________________________________
Print Name
______________________________________
Signature
______________________________________
Print Name of Applicant (if other than owner)
_______________________________________
Signature
_______________________________________
Signature of Applicant (if other than owner)
( )
Print Name of California Civil Engineer/Land Surveyor Phone Number
Mailing Address Email Address