HomeMy WebLinkAbout1. LLA25-0001 Project Info FormBiitte County Department of Development Services FORM NO
PLANNING DIVISION
DPL-017CountyCenterDrive,Orovillc,CA 95965PlanningCenterPhone530.552.370 1 Fax 530.538.7785
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Butte County
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Project #(Staff Use Only)PROJECT INFORMATION FORM
ASSESSOR'S PARCEL NUMBER:^|
TELEPHONE:
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APPLICANTS NAME:(If applicant is different from owner an affidavit is required.)
STREET,CITY,STATE,&ZIP CODE
E-MAIL:
ADDRESS:
FAX:
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FISCAL CONTACT:(the party that will handle permittees,invoices and other financial concerns for this application)
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STREET,CITY,STATE,&ZIP CODE TELEPHONE:ADDRESS:
E-MAIL:
OWNER'S NAME:TELEPHONE:
STREET,CITY,STATE,&ZIPCODE;
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ADDRESS:
PROPERTY INFORMATION
NAME OF PROPOSED PROJECT (if any)
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SITE SIZE (in square feet or a_cres)
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LOCATION OF PROJECT (major cross streets and address,if any)/g37 /STV srrt^
GENERAL PLAN EXISTING LAND USE /^k/<:^^hs/shhPd/JZONE PROPOSED LAND USEAt>;)/J^7^SthiP/l-e'S
EXISTING STRUCTURES (square feet)
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(CheckOne)^^3wOPERTY is or PROPOSED TO BE SEWEREDDpROPERTYisORPROPOSEDTOBEONSEPTIC
PROPOSED STRUCTURES (square feet)UNDER WILLIAMSON ACT C^RACT□ves lo
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IS OR PROPOSED TO BE ON PUBLIC WATER‘Sproperty
□PROPERTY IS OR PROPOSED TO BE ON WELL WATER
APPLICATION TYPE (check ail that apply)
□MINORVARIANCE
□VARIANCE
□CERTIFICATEOFMERGER
□TENTATIVESUBDIVISIONMAP
□COMMUNICATIONSFACILITYUP/MUP □TENTATIVE PARCELMAP
□WAIVER OF PARCELMAP
□CERTIFICATE OF CORRECTION
□RE20NE
□GENERAL PLAN AMENDMENT
□MININGANDRECLAMATIONPUN
□DEVELOPMENT AGREEMENT
□other
□ADMINISTRATIVEPERMIT
□LEGAL LOT DETERMINATION
□CONDITIONALUSE PERMIT
□MINORUSEPERMIT
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PROJECT DESCRIPTION
FULL DESCRIPTION OF PROPOSED PROJECT (Attach necessary sheets.If this application isfora land division,describe the number and size of parcels.)
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OWNER CERTIFICATION
I CERTIFY THAT I AM PRESENTLY THE LEGAL OWNER OR THE AUTHORIZED AGENT OF THE OWNER OF THE ABOVE DESCRIBED PROPERTY.
FURTHER,1 ACKNOWLEDGE THE FILING OF THIS APPLICATION AND CERTIFY THAT ALL OF THE ABOVE INFORMATION IS TRUE AND
hthisapplication.)ACCURATE.(If an agent is to be authorized,execute an affidavit of authorjza^on a^jndudethe affidavit ^
SIGNATURE:'
Please contact Planning Division Staff with any questions.^dotu(~J
DATE: