HomeMy WebLinkAbout1.LLA24-0007 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 dsµl�nn ing•c1'bullecoun l v. ncl
PROJECT INFORMATION FORM
FORM NO
DPL-01
Project # (Staff Use Only)
APPLLCANT'S NAME: (If appljcant is different from owner an affidavit is required.) ASSESSOR'S PARCEL NUMBER: .S +, ve ,f.,,.." 0.2 � - 0 tJ -"-02·1-010-()5,f" ADDRESS: 0 � srEET, CflY, STATE, & ZIP CODE /} S r if rra.� "'-\c J) r, c "'-·; L't.> (..,:"l_ 9 S-'r TELEPHONE: (530)S2I -/66-c:J
FAX:
FISCAL CONTA __ : (the party that will handle permitjees, invoices and other financia I concerns for this application)
�c..�(? le c:l, bo ltf' ADDRESS: STREET, Cl1Y, STATE, & ZIP CODE TELEPHONE:
E-MAIL:( )
. ADDRESS: _ / / / STREET'.J CITY, STATE, ZIPCODp /" *.'.<.Jy-o C'<..l.dd; � \ o 4t1·i • Oc(?e;:,>1.1",df'1. L. �J PROPERTY INFORMATION
NAME OF PROPOSED PROJECT(if any) /( SITE SIZE (in square feet or acres) .J, s;-6 ec.c f-..e-treet and address, if any) :Xot£ f<,.:;
EXISTING STRUCTURES (square feet)
EXISTING
ct-UNDER WILLIAMSON ACT CONTRACT Dves !El No (Check One) □PROPERTY IS OR PROPOSED TO BE SEWERED 0 PROPERTY IS OR PROPOSED TO BE ON SEPTIC
(Check One) 0 PROPERTY IS OR PROPOSED TO BE ON PUBLIC WATER0 PROPERTY IS OR PROPOSED TO BE ON WELL WATER
□ADMINISTRATIVE PERMIT0 LEGAL LOT DETERMINATION□CONDITIONAL USE PERMIT0 MINOR USE PERMIT□COMMUNICATIONS FACILITY UP /MUP� LOT LI NE ADJUSTMENT
APPLICATION TYPE (check all tllat apply) 0 MINORVARIANCE O CERTIFICATEOFCORRECTION 0 VARIANCE O REZONE □CERTI Fl CATE OF MERGER O GENERAL PLAN AMENDMENT □TENTATIVE SUBDIVISION MAP O MINING AND RECLAMATION PLAN 0 TENTATIVE PARCEL MAP O DEVELOPMENT AGREEMENT 0 WAIVEROFPARCELMAP □OTHER
PROJECT DESCRIPTION
----------
FULL DESCRIPTION OF PROPOSED PROJECT (AUach necessar: sheets. If this application is for a l�nq �ivision, describe the number an� size a/parcels.) IVloLrf, Fu4/..:Ji D)._'\ -D9o-_o37 ·f>1-ow, ,-t� C',:_._it'tc'i....� jl)C.,__·7\pv--. +e> �Vlt> fkev-l0ca...-t "9v\. �.): ✓�........ fq__r,:-e( :& 6>>fl-��o ·-038, 3v ft---.
(1c...r c::c: / j c,._r(: P't.."' le,-,t� :5·(,.,. W'·-f' � "'' h,f'✓ � I..,(
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: _______________________ _
Please contact Planning Division Staff with any questions.