Fillable PLANNING APPLICATION Donation Collection Box (DCB) Permit Pursuant (City of Lake Forest)

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PLANNING APPLICATION Donation Collection Box (DCB) Permit Pursuant (City of Lake Forest)

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The PLANNING APPLICATION Donation Collection Box (DCB) Permit Pursuant (City of Lake Forest) form is 2 pages long and contains:

  • 2 signatures
  • 8 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for City of Lake Forest

BROWSE CITY OF LAKE FOREST (CA) FORMS

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City of Lake Forest 100 Civic Drive, Lake Forest, CA 92630 (949) 461-3460 Fax (949) 461-3512 www.lakeforestca.gov Revised 07/29/20
PROJECT INFORMATION:
Address(s) of Property where Donation Collection Box is proposed
to be located
:
_________________________________________________________
_________________________________________________________
“Donation Collection Box (DCB)” or “Box” means any metal, plastic, cardboard or wooden box, bin, container, trailer, accessory
structure, or similar facility located outside of an enclosed building or in a parking lot or other public area of a private property, provided
by a person, organization, or collection center for the primary purpose of receiving or storing donated Salvageable Personal Property,
including household goods, clothing, textiles, toys, and other similar small items that are left unattended without an on-site operator.
APPLICANT/OPERATOR INFORMATION:
Name: _______________________________________________ Organization: ______________________________________
Type of business entity registered: _______________________________________________________________________________
Telephone No: ________________________________________ E-Mail: ___________________________________________
Mailing Address: _____________________________________________________________________________________________
City: ________________________________________________ State: _____________ Zip Code: _____________________
CHECK APPLICABLE BOX:
☐ List attached of all partners or limited partners of a partnership applicant, all members of an LLC applicant, all officers and directors
of a non-publicly traded corporation applicant, all stockholders owning more than 5% of the stock of a non-publicly traded corporate
applicant, and any other person who is financially interested directly in the ownership or operation of the business, including all aliases
,
c
ompany/organization name, address, telephone number, and e-mail address. ☐ N/A
CONTACT FOR ALL MATTERS RELATED TO DONATION COLLECTION BOX UPON APPROVAL OF PERMIT:
Name: ______________________________________________ Organization: ______________________________________
Telephone No: ________________________________________ E-Mail: ___________________________________________
Mailing Address: _____________________________________________________________________________________________
City: ________________________________________________ State: _____________ Zip Code: _____________________
PROPERTY OWNER INFORMATION:
Name: _____________________________________________________________________________________________________
Telephone No: ________________________________________ E-Mail: ___________________________________________
Mailing Address:______________________________________________________________________________________________
City: ________________________________________________ State: _____________ Zip Code: _____________________
CHECK APPLICABLE BOX:
☐ List of all entities which may share or profit from items collected via the DCB attached
. ☐
N/A
PLANNING APPLICATION
Donation Collection Box (DCB) Permit Pursuant to LFMC Ch. 9.142
FOR CITY USE ONLY:
Date Submitted:
Fee Amount:
Zoning:
GP:
APN: _______________________________________
City of Lake Forest 100 Civic Drive, Lake Forest, CA 92630 (949) 461-3460 Fax (949) 461-3512 www.lakeforestca.gov Revised 07/29/20
Dimensions of proposed DCB: ______________________________________________________________________________
☐ Elevations of proposed DCB attached. ☐ Details of proposed signage attached
☐ To-scale site plan depicting all existing and proposed site improvements and the location of proposed DCB attached.
☐ To-scale map demonstrating that the location of the Property relative to the property with the closest existing DCB meets 750 ft.
minimum separation requirement, as measured from the Property line to Property line, attached.
I hereby certify, under penalty of perjury, that all of the foregoing information is true and correct and agree to indemnify and hold the
City harmless concerning the City’s approval of the Permit, the operation and maintenance of the DCB, and any matter relating to the
DCB, including without limitation the City’s enforcement of LFMC Ch. 9.142 and the City’s removal of the box in accordance with LFMC
Ch. 9.142. Furthermore, I agree to comply with the standards and requirements of LFMC Ch. 9.142 and to fully reimburse the City for
the full cost of processing this application.
___________________________________________________ ________________________________________________
Applicant's Signature Date
I hereby consent to placement of the DCB on the Property, acknowledge responsibility for compliance with the provisions of LFMC Ch.
9.142, and agree to indemnify and hold the City harmless concerning the City’s approval of the Permit, the operation and maintenance
of the DCB, and any matter relating to the DCB, including without limitation the City’s enforcement of LFMC Ch. 9.142 and the City’s
removal of the box in accordance with LFMC Ch. 9.142:
___________________________________________________ __________________________________________________
Property Owner's Signature Date
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PLANNING APPLICATION Donation Collection Box (DCB) Permit Pursuant (City of Lake Forest)

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Completed 18 February 2021

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