HomeMy WebLinkAboutADM21-0013 Agent Authorization Form1 of 1 AGENT AUTHORIZATION
'ro Butte County. Department of Development Son ices
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Print Name of Agent Phone Number
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Mailing Address
is hemby authorized to process this application on my/our property, identified as Butte County Assessors Parcel Numbers)
This outhorimtion allows representation for all applications, hearings, appeals, ele. and to sign all docunwnls necessary ter
said processing, including mitigation and conditions of approval, but not including d«uments(s) relating to title interest.
Owner(s) of Record (sign and print name)
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Print Name Pont Nam:
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Print Name ofApplicant (if either than owner) Signature of Applicant (i/nthrr than nomer)
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Print Name of California Civil Engincer'Land Surveyor Phone Number
Address
contact Planning Division Staff with