HomeMy WebLinkAboutMISC24-0010 Agent AuthButte County Department of Development Services FORM NOPLANNINGDIVISION
7 County Center Drive,Oroville,CA 95965
Planning Center Phone 530.552.3701 Fax 530.538.7785
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AGENT AUTHORIZATION
To Butte County,Department of Development Services;
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Phone Number
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Print Name of Agent
Email AddressMailingAddress
Is hereby authorized to process this application on my/our property,identified as Butte County Assessors
Parcel Number(s)O -VI 4
This authorization allovws 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)fvK e.'f
Print Name ^
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Print Name
Signature Signature
Print Name Print Name
Signature Signature
Print Name of Applicant (if other than owner)Signature of Applicant (if other than owner)
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Print Name of California Civil Engineer/Land Surveyor Phone Number
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Mailing Address Email Address
Please contact Planning Division Staff with any questions.