HomeMy WebLinkAboutMER24-0007 Agent AuthButte County Department of Development Services FORM NO
PLANNING DIVISION
7 County Center Drive,Oroville,CA 95965
Planning Center Phone 530.552.3701 Fax 530.538.7785
dsolanning@.butlecountv.net
DPL-02ButteCounty
u C A I I F O K N I A
AGENT AUTHORIZATION
To Butte County,Department of Development Services:
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Print Name of Agent
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Is hereby authorized to process this application on my/our property,identified as Butte County Assessors
Parcel Number{s)
Phone Number
Email Address
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This authorization allows representation for all applications,hearings,appeals,etc.and to sign all documents
necessary for said processing,Including mitigation and conditions of approval,but not including documents{s)
relating to title interest.
Owner^s)of Record (sign and print name)
Print Name
Signature Signature
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Print Name Print Name
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Print Name of Applicant f//other t/ionowner^Signature of Applicant (if other than oivnerj
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Print Name of California Civil Engineer/Land Surveyor Phone Number
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Please contaa Planning Division Staff with any questions.