Community City of Roseburg: Community Development Department

900 SE Douglas Avenue – 3rd Floor, Roseburg, OR 97470

Development Phone: 541-492-6750; Email: cdd@cityofroseburg.org

Website: CityofRoseburg.org

**Office Use**
SITE PLAN REVIEW APPLICATION Application Number:
Category of Development: Type of Work: (Check all that apply) __________________
☐ One or Two Family Dwelling ☐ New Construction
✔
Date Received:
☐ Multi-Family ☐ Addition/Alteration/Change of Use
__________________
☐ Commercial/Industrial
✔
☐ Demolition
☐ Other: ______________________ ☐ Other: ______________________ Route to:
☐ Fire Dept.
Project Site Information:
2844 NW Aviation Drive ☐ RUSA
Site Address: __________________________ Suite/Apt. No: ________________
☐ Public Works
Roseburg, OR
City/State/Zip: _________________________ 27-06W-01CD-04300
Parcel I.D. No: ________________
☐ ODOT
None. Vacant Land
Previous uses at this Site (Last 10 years): __________________________________
Courtesy Copy:
Project Description: ☐ Pacific Power
Development of a 3,885 square foot In-N-Out Burger restaurant with ☐ Avista Utilities
drive through service and outdoor patio seating. Associated site work
includes 71 parking stalls and 26,173 square feet of landscape area Required Plans:
☐ Site Plan
Building Area Impervious Area (parking, driveways, etc.) ☐ Floor Plan(s)
0
Existing (sq. ft.): _________________ 0
Existing (sq. ft.): __________________ ☐ Building Elevations
3,885
New (sq. ft.): ____________________ New (sq. ft.): ____________________ ☐ Parking Plan/Counts

**Sign Permits
[Grab your reader’s attention only**
with a great quote from the document or use this ☐ Landscape Plan
space Signs
Existing to emphasize a key point. To place this textSigns
Proposed box anywhere on the page, ☐ Grading Plan
just drag it.]
Type/Amount ____________________ Type/Amount _____________________ ☐ Elevation Certificate
Total Sign Area _____________ sq. ft. Total Sign Area _______________ sq. ft. ☐ Geo-technical Report

Applicant(s) Information: ☐ Owner

✔
☐ Tenant ☐ Contractor/Agent ☐ Improvement Plan(s)

In-N-Out Burger, Inc. (626)813-8226 ☐ Fire Dept. Checklist

Name: ________________________ Phone: ___________________
13502 Hamburger Lane cyee@innout.com ☐ Other:
Address: _______________________ Email: ____________________
____________________
Baldwin Park, CA 91706
City/State/Zip: __________________ Preferred contact: Email ☐ Phone ☐
✔
Additional Review:

Property Owner(s) Information: (If Different from Applicant) ☐ Floodplain

Investors X, LLC 541-245-6201 ☐ Historic

Name: ____________________
2870 Nansen Dr
Address: ___________________
Medford, OR 97504
City/State/Zip: ______________
Phone: ___________________
☐ Hillside Development
Email: ____________________
Land Use File:
______________