HomeMy WebLinkAbout078-310-067 SEWW25-0005 TPM ROW PRE APPLICATION\\btN
Danette York, M.P.H., Director
Robert Bernstein, M.D., Health Officer
I buttecounty.net/publichealth
Public Health Department
Environmental Health Division
202 Mira Loma Drive
Oroville, California 95965
T:530.552.3880
F: 530.538.5339
( ) orHER
Location of Property
Assessor's Parcel Number(s)O7B 3/O - d"7
PROJECT DESCRIPTION (must include an attached map and a brief verbal description)
Applicant
Address
Phone Number
Pre-Application Review for Land Development Project
(Please check appropriate box)
( ) TENTATIVE SUBDIVISON MAP
O TENTATIVE PARCEL MAP
( ) usE PERMTT ( ) ADM|N USE PERMIT
( )soll wArvER
( )MTNOR USE PERMIT
owner LJctln*-) "CJe phone Number s-Bs 37c cvG6
Address 4f f-JL- Fw g*r,/L cp 9n66
Engineer or Surveyor (h-,' , G->. i&7 Phone Number Sso -s iq 336 2
Address tmait /h,kin4ee 0 f,"l'.oo,Lor1.l
Correspondence should go to: ( )Applicant ( ) Owner lr; fngineer/Surveyor
Applicants are strongly advised to consult with the Department of Development Services
before beginning this review to make sure they are aware of existing restrictions or conditions
on the parcel that could preclude the value of conducting this pre-application review.
Site evaluations completed during this review will be retained in our files and used to determine
and n of wastewater systems that may be installed on the parcel in the future.
Signature Date /-Z- Z S-
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the
Department Use Only
E.H.S. Reviewing Application
Receipt No.Date