HomeMy WebLinkAboutLLA24-0012 Project Info FormBulte County Department of Development Services FORIVl NO
PLANNING DIVISION
DPL-017CountyCenterDrive,Oroville,CA 95965
Planning Center Phone 530.552.3701 i-'ax 530.538.7785
dsnlanningf/buuecoiiniv.net
Butte County
u C A I t F O R N I A
Project #(Staff Use Only)PROJECT INFORMATION FORM LLAm-OOlL
APPLICANT'S NAME:(If applicant is different from owner an affidavit is required.)TT i'/n ^
ADDRESS:,/
ASSESSOR'S PARCEL NUMBER:
vv,m
STREET,CITY,STATE,&ZIP CODE TELEPHONE:
FAX:E-MAIL:.t
C7FISCALCONTACT;(the party that will handle permit fees,invoices and other financial concerns for this application)31 y >1 ^STRE^CITY,STATE,&ZIPCODE
CoU Si ^E-MAIL ^
l~,\x ^>1>7
TELEPHONE:ADDRESS:
'l.o=>*^WV^j
1
1/-/e^'t In LA r\^-g v>^>>T vn>TELEPHONE:OWNER'S NAME:37
(530 )8 6W-qiq.-?,^A-f5~‘?77●2-Y i/y<V'f'-so
STREET,CITY,STATE,&ZIPCODE:ADDRESS:
PROPERTY INFORMATION
NAME OF PROPOSED PROJECT (if any)
n I ck
SITE SIZE (in square feet or acres)2^
LOCATION OF PROJECT (major cross streets and address,if any)In dnEJ^STING LAND US PROPOSED LAND USEGENERALPLANZONEFf?-5 I
ORUCTURES (square feet)QlO^PROPOSED STRUCTURES (square feet)UNDER WILLIAMSON ACT CO□ves ONJEhRACTEXISTING
No
(Check One)
tPERTY 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 □pj
APPLICATION TYPE (check all that apply)
□MINORVARIANCE
□VARIANCE
□CERTIFICATE OF MERGER
□TENTATIVESUBDIVISION MAP
□CERTIFICATEOFCORRECTION
□REZONE
□GENERAL PIAN AMENDMENT
□MININGANDRECLAMATIONPLAN
□DEVELOPMENT AGREEMENT
□other
□ADMINISTRATIVEPERMIT
□LEGAL LOT DETERMINATION
□CONDITIONALUSEPERMIT
□MINORUSEPERMIT
□COMMUNICATIONSFACILITYUP/MUP □TENTATIVE PARCEL MAP
Slot LINE ADJUSTMENT □WAIVER OF PARCEL MAP
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.)
OWNER CERTIFICATION
I CERTIFY THAT 1 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 ^d include the affidavit with this application.)
c
2-07-^SIGNATURE;4 ●i^n Staff with any questions.Please contact Planni