HomeMy WebLinkAbout2.UP25-0003 Project Info Form Butte County Department of Development Services PLANNING DIVISION
7 County Center Drive, Oroville, CA 95965 Planning Center Phone 530.552.3701 Fax 530.538.7785
dsplanning@buttecounty.net
PROJECT INFORMATION FORM Project # (Staff Use Only)
APPLICANT’S NAME: (If applicant is different from owner an affidavit is required.) ASSESSOR’S PARCEL NUMBER: - - ADDRESS: STREET, CITY, STATE, & ZIP CODE TELEPHONE:
( ) -
E-MAIL: FAX:
( ) -
FISCAL CONTACT: (the party that will handle permit fees, invoices and other financial concerns for this application)
ADDRESS: STREET, CITY, STATE, & ZIP CODE TELEPHONE:
( ) -
E-MAIL:
OWNER’S NAME: TELEPHONE:
( ) -
ADDRESS: STREET, CITY, STATE, & ZIP CODE:
PROPERTY INFORMATION
NAME OF PROPOSED PROJECT (if any) SITE SIZE (in square feet or acres)
LOCATION OF PROJECT (major cross streets and address, if any)
ZONE GENERAL PLAN EXISTING LAND USE PROPOSED LAND USE
EXISTING STRUCTURES (square feet) PROPOSED STRUCTURES ( square feet) UNDER WILLIAMSON ACT CONTRACT Yes No
(Check One) PROPERTY IS OR PROPOSED TO BE SEWERED PROPERTY IS OR PROPOSED TO BE ON SEPTIC
(Check One) PROPERTY IS OR PROPOSED TO BE ON PUBLIC WATER PROPERTY IS OR PROPOSED TO BE ON WELL WATER
APPLICATION TYPE (check all that apply) ADMINISTRATIVE PERMIT MINOR VARIANCE CERTIFICATE OF CORRECTION LEGAL LOT DETERMINATION VARIANCE REZONE CONDITIONAL USE PERMIT CERTIFICATE OF MERGER GENERAL PLAN AMENDMENT MINOR USE PERMIT TENTATIVE SUBDIVISION MAP MINING AND RECLAMATION PLAN COMMUNICATIONS FACILITY UP/MUP TENTATIVE PARCEL MAP DEVELOPMENT AGREEMENT LOT LINE ADJUSTMENT WAIVER OF PARCEL MAP OTHER __________________________
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.)
I CERTIFY THAT I 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 and include the affidavit with this application.)
DATE: SIGNATURE:
Please contact Planning Division Staff with any questions.
OWNER CERTIFICATION
FORM NO DPL-01