Cit
y
of Madera – Plannin
g
Departmen
t
205 W. 4
th
Street
Madera, CA 93637
Phone: (559) 661-5430
Fax: (559) 674-2972
planning@cityofmadera.com
ANX
CUP
DU
GPA
Home Occupation HOP
LLA
Ordinance Text Amend OTA
PPL
PPR
REZ
SPR
SPL
TPM
TSM
TUP
VAR
ZAP
[ ] ENV
(Paid Separately)
TOTAL
$
Other
[ ]
APPLICATION FEES are NON-REFUNDABLE.
Not Applicable
Determination of Use
Fish & Game Fee
To Be Determined
[ ]
DEVELOPMENT
APPLICATION
APPLICANT
[ ]
Name:
Address:
[ ]
Fax:
[ ]
[ ]
Zoning Administrator
[ ]
Phone:
[ ]
City/Zip:
[ ]
Cell Phone:
[ ]
E-mail:
[ ]
Site Plan Review
PROPERTY OWNE
R
[ ]
[ ] Same as Applicant
[ ]
Name:
[ ]
Address:
[ ]
City/Zip:
[ ]
Phone:
[ ]
Cell Phone:
[ ]
Property Owner's Signature
Fax:
E-mail:
REPRESENTATIVE
[ ] Same as Applicant
Contact:
Address:
City / Zip:
Phone:
Cell Phone:
Fax:
E-mail:
PROJECT DESCRIPTION
Address: APN:
Proposed General Plan:
Current Zone:
The information provided in this application is true and accurate to the best of my knowledge.
Proposed Use:
Current Use:
SIGNATURE(S) – BOTH SIGNATURES ARE REQUIRED
__________________________________ , to act on my behalf on matters pertaining to this application.
Applicant's Signature Date
Property Owner's Signature (if different from applicant)
Date
Print Owner Name
Print Applicant / Representative Name
Date
Note: If more than one owner, a separate page must be attached listing the names and addresses of all persons (If a corporation, list officers
and pricipals) having interest in the property ownership.
I, _________________________________ , am the owner of the property described in this application and hereby authorize,
DECLARATION OF OWNERSHIP / LEGAL AGENC
Y
Annexation
Conditional Use
General Plan Amend
Prelim Project Review
Proposed Zone:
Current General Plan:
Building Use Valuation: $
Lot Line Adjustment
Environmental Fee
[ ] Variance
Tentative Subdiv Map
Specific Plan
Rezoning
Precise Plan
Tentative Parcel Map
Temp Use of Land
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