HomeMy WebLinkAboutMEXT25-0006 DPL-02 Agent Auth
AGENT AUTHORIZATION
To Butte County, Department of Development Services:
( ) Print Name of Agent Phone Number
Mailing Address
is hereby authorized to process this application on my/our property, identified as Butte County Assessors Parcel Number(s)
This authorization allows 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)
______________________________________
Print Name
_______________________________________
Print Name
______________________________________ Signature
_______________________________________ Signature
______________________________________
Print Name
_______________________________________
Print Name
______________________________________
Signature
______________________________________
Print Name of Applicant (if other than owner)
_______________________________________
Signature
_______________________________________
Signature of Applicant (if other than owner)
( )
Print Name of California Civil Engineer/Land Surveyor Phone Number
Mailing Address Email Address