HomeMy WebLinkAboutMER23-0005 Proj. Info FormBulte Counry Department of Development Services FORM yo
PLANNING DIVISION
7 County Center Drive. Oroviile, CA 95965
Planning Center I’lmiic 5.10.552.3701 Fax 530.538.7785
PuU ranim v .iieit Butte Gauiity^
l_C A l t F O (f
Project a (Staff Use Only)PROJECT INFORMATION FORM
ASSESSOR’S PARCEL NUMBER: ^
CQ\ -0 7>0 - OHi ^ 0(£> |-03Ci-0H5
APPLICANT’S NAME: (if applicant is different from owner an affidavit is required.)fv\vUcr
TELEPHONE;STREET, GTV. STATE, & ZIP CODEADORESS:
fit b/u’grlA CJT. CA
e-maIl T AT ’ . .FAX;
FISCAL CONTACT: (the party that will handle permit fees, invoices and other financial concerns for this application)
TELEPHONE:STREET, CITY, STATE, & ZIP CODEADORESS:
E-MAIL;
TELEPHONE;OWNER'S NAME;
VM A - \g7 S
STREET, CITY, STATE, &ZIPCODE;ADDRESS;
CA <^45^
PROPERTY INFORMATION
Oy
SITE SIZE (in square feet or acres)NAME OF PROPOSED PROJECT (if any)
LOCATION OF PROJECT (major cross streets and address, if any)
PROPOSED LAND USEEXISTING LAND USEGENERAL PLANZONE
UNDER WILLIAMSON ACT CONTRACT
Dves Dno
PROPOSED STRUCTURES (squarefeet)EXISTING STRUCTURES (square feet)
(Check One)
DpROPERTY is or PROPOSED TO BE ON PUBLIC WATER
□ property is or PROPOSED TO BE ON WELL WATER
(Check One)
□ property is or PROPOSED TO BE SEWERED
□ property is or proposed to be on septic
APPLICATION TYPE (check all that apply)
□ IV1I NOR VARIANCE
□ VARIANCE
□ CERTIFICATE0FMER6ER
□ CERTIFICATEOFCORRECTION
□ REZONE
□ GENERAL PLAN AMENDMENT
□ MININGANORECLAMATIONPLAN
□ DEVELOPMENT AGREEMENT
l^OTHER Z p^revA^
□ ADMINISTRATIVE PERMIT
□ LEGAL LOT DETERMINATION
□ CONDITIONALUSEPERMIT
□ TENTATIVESUfiDlVlSlON MAP
□ COMMUNICATION5FACILITYUP/MUP □ TENTATIVE PARCELMAP
□ \WAIVER OF PARCELMAP
□ MINORUSEPERMIT
□ LOTLINEADJUSTMENT
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.)
X A^-Scvv.'^ViiJ
\OCy-CceX .?
c D VV% CP
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 authorha^Kjn and indude the affidavit-with this application.)
Please contact Planning Division Staff wtih any questions.
SIGNATURE:DATE:
;
T T ■rrI. 7 irf-/
V
i!
r
j
-?r ●:rT-:r^“TT--rr;●r\:i-
;■- S i 't.
A‘
1
I ●>
●>
●v'
V.'
-1