HomeMy WebLinkAboutApplication APPLICANT 5/29/2013 • •
City of Springfield 2 SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477 IMILL /
Annexation Application Type IV
Application Type (Applicant: Check one)
Annexation Application Pre-Submittal: ❑
Annexation A. .lication Submittal:
Required Proposal Information 1,' (Applicant: Complete This Section)
Property Owner: � P or� A • Itirjti<tj Phone: 45-0511-3057
Address: -700 So 57 '14 54- Fax: (590754.-1402
3?,-.n9 ci.V D C-. ` P-11g, E-mail: don rn hor—t,
Owner Signature: ; r „iCE— V"1O—tl—• CO '
Owner Signature: W
Agent Name: Phone
Company: Fax:
Address: E-mail
Agent Signature:
If the applicant is other than the owner, the owner hereby grants permission for the applicant to act in his-or her behalf, except;'
where signatures of thetowner of record-are required, only th1e,,.owner may sign the _
:petition:_
ASSESSOR'S MAP NO: I / rg OZ-O 1 7
'1 TAX LOT NO(S): /00
Property Address: eja7 So 57-of Skvee f Spriv1.CJcI OE_ 9 7 4.7 0
Area of Request: Acres: . 67 I Square Feet:
Existing Use(s) "Z',.5 A fia
of Property:
Proposed Use
of Property:
. _ _ _ .. ,r... •
Re uired Pro ert Information, Cit
q p y: ( y.Intake Staff: Complete;This Section)
Reviewed By:
Case No.: X �3_ 06OO� Date: yyt, gey; (initials) TaY�
Application Fee: 3 ip(p8 13 Postage Fee: 34,9-9 Total Fee: / qc,��
\kat. 6.c1--: _/ 8 3:4 Date Received: OlJ 13 ON)
MAY 2 9 2013 Page 8 of 16
Original Submittal
Owner Signatures
This application form is used for both the required pre-submittal meeting and subsequent
complete application submittal. Owner signatures are required at both stages in the application
process.
An application without the Owner's original signature will not be accepted.
Pre-Submittal
The undersigned acknowledges that the information in this application is correct and
accurate for scheduling of the Pre- Submittal Meeting. If the applicant is not the
owner, the owner hereby grants permission for the applicant to act in his/her behalf.
I/we do hereby acknowledge that I/we are legally responsible for all statutory
timelines, information, requests and requirements conveyed to my representative.
Owner: _
Date:
Signature
Print
Submittal
I represent this application to be complete for submittal to the City. Consistent with the completeness check
performed on this application at the Pre-Submittal Meeting, I affirm the information identified by the City as
necessary for processing the application is provided herein or the information will not be provided if not otherwise
contained within the submittal, and the City may begin processing the application with the information as
submitted. This statement serves as written notice pursuant to the requirements of ORS 227.178 pertaining to a
complete application.
Owner:
Date: '/Zy �13
Signature
elL.SDbin VA • \Aovr o t4
Print
•
Date Med:
M Rec 2 9 20ive13
Original Subm.ittai___---
Page 9 of 16
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X.
FORM 2
OWNERSHIP WORKSHEET
(This form is NOT the petition)
(Please include the name and address of ALL owners regardless of whether they
signed an annexation petition or not.
OWNERS
Property Designation Assessed Imp. Signed Signed
(Map/lot number) Name of Owner Acres Value Y/ N Yes No
9--ot—by=1`i-loo Dntv.0 v-Iniz-raa ul y
LPv ve V� �fi� U
TOTALS:
TOTAL NUMBER OF OWNERS IN THE PROPOSAL •
NUMBER OF OWNERS WHO SIGNED Z
PERCENTAGE OF OWNERS WHO SIGNED / OU
TOTAL ACREAGE IN PROPOSAL 6,7
ACREAGE SIGNED FOR 6,7
PERCENTAGE OF ACREAGE SIGNED FOR 100
TOTAL VALUE IN THE PROPOSAL laSit-10I7
- -- - VALUE CONSENTED FOR Vice 400
PERCENTAGE OF VALUE CONSENTED FOR 100
Date Received:
• 13 of 16
MAY 2 9 2013
l Original Submittal
•
FORM 3 •
SUPPLEMENTAL INFORMATION FORM
(Complete all the following questions and provide all the requested information. Attach
any responses that require additional space, restating the question or request for
information on additional sheets.)
Contact Person: `Don 44-art
E-mail: L1on wr, , tow.,
Supply the following information regarding the annexation area.
• Estimated Population (at present): 7
• Number of Existing Residential Units.: •
• Other Uses: nn P
• Land Area: 1.1 total acres
• Existing Plan Designation(s): LT)R •
• Existing Zoning(s): 1—DR _
• Existing Land Use(s): 1Zeg�t,rX,`�a
• Applicable Comprehensive Plan(s): p-.e.�-o ?Lin
• Applicable Refinement Plan(s): N / Pr
• Provide evidence . that the annexation is consistent with the applicable
comprehensive plan(s) and any associated refinement plans.
4cr•re cto,-. rtto._w-j -to 010+0-‘.r C-C4 se.,.ae,r so-.,i u�
• Are there development plans associated with this proposed annexation?
Yes ✓ No
If yes, describe.
` 1 16 le
• Is the proposed use or development allowed on the property under the current
. plan designation and zoning?
Yes ✓ No
• Please describe where the proposed annexation is contiguous to the city limits
(non-contiguous annexations cannot be approved under_5.7-140, Criteria).
Nor rArt1
Date Received:
Page 14 of 16
MAY 2 9 2013
)riginal Submittal
• •
Does this application include all contiguous property under the same ownership?
Yes No
If no, state the reasons why all property is not included:
• Check the special districts and others that provide service to the annexation
area:
❑ Glenwood Water District ❑ Rainbow Water and Fire District
❑/Eugene School District ❑ Pleasant Hill School District
6 Springfield School District 0 McKenzie Fire & Rescue/
❑ Pleasant Hill RFPD L� Willakenzie RFPD
❑ EPUD IISUB
11Willamalane Parks and Rec District ❑ Other
• Names of persons to whom staff notes and notices should be sent, in addition to
applicant(s), such as an agent or legal representative.
NOra�
(Name) (Name)
(Address) (Address)
(City) (Zip) (City) (Zip)
(Name) (Name)
(Address) (Address)
(City) (Zip) (City) (Zip)
Date Received: •
MAY 292013
)rlginal Submittal
i Page 15 of 16
(
• •
•
FORM 4
WAIVER OF ONE YEAR TIME LIMIT
FOR ANNEXATION PURSUANT TO ORS 222.173
This waiver of the time limit is for the following described property:
Map and Tax Lot Number Street Address of Property (if address has been
assigned)
ONE WAIVER OF TIME LIMIT FOR EACH PARCEL, PLEASE
We, the owner(s) of the property described above understand the
annexation process can take more than one year but desire to annex to have
City services. Therefore, we agree to waive the one-year time limitation on
this petition to annex established by Oregon Revised Statutes 222.173, and
further agree that this contract shall be effective [ ] indefinitely or [ ] until
. Date
Signatures of Legal Owners •
• Please print or type name Signature Date Signed
LCOG: L:IWCt2008 BOUNCHANGE TRANSITIONtAPPLICATION FORMS\SPRINGFIELO 110-03-08 UPDATED FORMS\PRE-SUBMITTAL ANNEXATION APPLICATION 10-07-08.00C
Last Saved: October 27,2010
•
Page 16 of 16
•
•
LEGAL DESCRIPTION
•
Tax Lot 100 of Lane County Oregon Assessor's Map 18-02-04-14, and a portion of the
right of way of South 57th Street in Springfield, Oregon; being more completely
described as follows:
Beginning at the Southwest corner of Parcel 3 of Land Partition Plat No. 2005-P1894,
• as filed for public record in the Office of the Lane County, Oregon Surveyor, in County
Surveyor's File No. 39332, on June 20, 2005, said point being on the east right of way
line of South 57th Street, said point being at an angle point on the Springfield City Limits
line;
thence on the Springfield City Limits line and the east right of way line of South 57th
Street South 130 feet;
thence continuing on said City Limits line and leaving said east right of way line East
194.40 feet;
thence continuing on said City Limits line South 150.75 feet; .
thence continuing on said City Limits line West 194.40 feet to a point on said east right
of way line;
thence continuing on said City Limits line West 30 feet, more or less to the centerline
of South 57th Street;
thence leaving said City Limits line and continuing on said centerline North 280.75 feet;
thence leaving said centerline East 20 feet, more or less to an angle point on said City
Limits line; •
thence on said City Limits line East 10 feet, more or less to the Point of Beginning.
•
Basis of bearing for this description is Partition Plat 2005-P1894.
Assessor's Map and Tax Lot numbers are current as of the date of this description.
RESnyr¢r D
•
Date Received: LA PROFESSIONAL
ND SURVEYOR
MAY 292013 •
s,y,ed oi.,„,2015
pe
Original Ut)i�'sltYi L.__ OREGON
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