HomeMy WebLinkAbout1.MUP22-0006_Project_Info_FormButte County Department of Development Services FORM NO PLANNING DIVISION
7 County Center Drive, Oroville, CA 95965 Planning Center Phone 530.552.3701 Fax 530.538.7785dsplannine@buttecounty.net
PROJECT INFORMATION FORM
DPL-01
Project# (Staff Use Only)
ASSESSOR'S PARCEL NUMBER: 0
FISCAL CONTACT: (the party that will handle permit fees, Invoices and other financial concerns for this application)
ADDRESS: STREET, CITY, STATE, & ZIP CODE TELEPHONE:
E-MAIL:
OWNER'S NAME:. � 3odil11J& L...i.c_
ADDRESS: STREET, CITY, STATE, & ZIP CODE:
EXISTING STRUCTURES (square feet)
PROPERTY INFORMATION
SITE SIZE (In square feet or acres)
PROPOSED STRUCTURES ( square feet)
PROPOSED LAND USE
UNDER WILLIAMSON ACT CONTRACT Oves DNo
(Check One) (Check One) 0 PROPERTY IS OR PROPOSED TO BE SEWERED 18.eROPERTY IS OR PROPOSED TO BE ON SEPTIC
�OPERTY IS OR PROPOSED TO BE ON PUBLIC WATER 0 PROPERTY IS OR PROPOSED TO BE ON WELL WATER
0 ADMINISTRATIVE PERMIT 0 LEGAL LOT DETERMINATION
�ONDITIONAL USE PERMIT
INOR USE PERMIT
--���
0 COMMUNICATIONS FACILITY UP/MUP 0 LOT LINE ADJUSTMENT
APPLICATION TYPE (check all that apply) 0 MINOR VARIANCE O CERTIFICATE OF CORRECTION D VARIANCE D REZONE
0 CERTIFICATE OF MERGER O GENERAL PLAN AMENDMENT 0 TENTATIVE SUBDIVISION MAP O MINING AND RECLAMATION PLAN 0 TENTATIVE PARCEL MAP O DEVELOPMENT AGREEMENT 0 WAIVER OF PARCEL MAP 00THER _________ _
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.) A� c,) 8,clb G.4( ;f,Jt1P,eee-zr7AfiJlc_ l'o �R PAC /,-1-'f.
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 CERTIE.Y THAT ALL OF THE ABOVE INFORMATION IS TRUE AND
ACCURATE. (If an agent is to be authorized, execute an affidavit of auth ude the affidavit with is application.)
DATE: I ( -30 -.2 (SIGNATURE: ���-!_/....,.¥.U,���ze��=-------
Please contact Planning Division Staff with any questions.
MUP22-0006