HomeMy WebLinkAboutUP23-0002.01_Project_Info_FormButte County Department of Development Services
PLANNING DIVISION
7 County Center Drive, Oroville, CA 95965
Planning Center Phone 530.552.3701 Fax 530.538.7785
dsplanning@buttecounty.net
PROJECT INFORMATIONFORM Project # (Staff Use Only)
APPLICANT’S NAME: (If applicant is different from owner an affidavit is required.) ASSESSOR’S PARCEL NUMBER:
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ADDRESS:STREET, CITY, STATE, & ZIP CODE TELEPHONE:
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E-MAIL:FAX:
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FISCAL CONTACT: (the party that will handle permit fees, invoices and other financial concerns for this application)
ADDRESS: STREET, CITY, STATE, & ZIP CODE TELEPHONE:
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E-MAIL:
OWNER’S NAME: TELEPHONE:
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ADDRESS:STREET, CITY, STATE, & ZIPCODE:
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)
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 (check all that apply)
ADMINISTRATIVE PERMIT
MINOR VARIANCE
CERTIFICATE OF CORRECTION
LEGAL LOT DETERMINATION
VARIANCE
REZONE
CONDITIONAL USE PERMIT
CERTIFICATE OF MERGER
GENERAL PLAN AMENDMENT
MINOR USE PERMIT
TENTATIVE SUBDIVISION MAP
MINING AND RECLAMATION PLAN
COMMUNICATIONS FACILITY UP/MUP
TENTATIVE PARCEL MAP
DEVELOPMENT AGREEMENT
LOT LINE ADJUSTMENT
WAIVER OF PARCEL MAP
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.)
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 tobe authorized, execute an affidavit of authorization and include the affidavit with this application.)
DATE:SIGNATURE:
Please contact Planning Division Staff with any questions.
OWNER CERTIFICATION
FORM NO
DPL-01
Assurance Development
1499 Huntington Drive, Suite 305, South Pasadena CA 91031 323 573 0045
jcosgrove@assurance-realty.com 626 322 0880
1499 Huntington Drive, Suite 305, South Pasadena CA 91031 323 573 0045
Peter Phelan 323 627 6139
US-CA-5442- Berry Creek 2500
FR-20 Raw Land Unmanned Wireless Facility
tbd 2500
Digitally signed by James Cosgrove Date: 2023.02.13 15:40:53 -08'00'
072-410-022
108 Campfire Road Oroville CA 95966
blewis@assurance-realty.com
4744 VE Ave. Oroville, CA 95966
Assurance Development
See attached cover letter that includes project description for the proposed unmanned wireless facility
UP23-0002