HomeMy WebLinkAboutB25-1462 REVISED AGENT FORM DPL02 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
To Butte County, Department of Development Services:
( )
Print Name of Agent PhoneNumber
_______________________________________________________________________________________________________________________
Mailing Address Email 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 Signature
_____________________________________________ ___________________________________________
Print Name of Applicant (if otherthan owner)Signature of Applicant (if other than owner)
( )
Print Name of California CivilEngineer/Land Surveyor Phone Number
Mailing Address Email Address
Please contact Planning Division Staff with any questions.
AGENT AUTHORIZATION
FORM NO
DPL-02
To Butte County, Department of Development Services:
Owner(s) of Record (sign and print name)
_____________________________________________
Print Name of Applicant (if other than owner)
_____________________________________________
Signature of Applicant (if other than owner)
19606 94th Ste. E Bonneylake WA 98391 dukeda2003@yahoo.com
056-020-139
Don Brown Survivor Trust
Nicole Peterson, trustee
Debra Duke Watson
Debra Duke Watson 5305915999