HomeMy WebLinkAboutApplication APPLICANT 5/30/2013 • •
City of Springfield 3 SPRINGFIELD
Development Services Department
225 Fifth Street
Springfield, OR 97477
Application Type IV
Application Type , !J' It . (Applicant: Check one);
Annexation A. .lication Pre-Submittal: u
Annexation A. .Iication Submittal: ❑
Required Proposal Information (App/icant Complete This Section).
Pro.ert Owner: • RR VAN ESNSN Phone: 5 /.75/P7;
Address: • • • Fax: Sy/- 71// ?990
E-mail:
i
Owner Signature: , : 4 &co1Ct1Tf.NC
Owner Signature:
,. Phone
Com.an : 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 the owner of record are required, only the owner may sign the petition.
ASSESSOR'S MAP NO: IS 2- 0& l f TAX LOT NO S : 700
Pro.ert Address: Vo76 MOAT S Teat-
Area of Re• uest: Acres: O.3C. S• uare Feet:
Existing Use(s) �� ;-t: - .E cE Alut oS U• I a.mE
of Property:
Proposed Use •
of Property:
Required-Property Information : 1(City (Intake Staff Complete This Section)
Case No.: DooI Date: J/30 13 Reviewed By: ac
13 / I initials p
Application Fee: ,0-73 Postage Fee: - Total Fee: &-0 • pv
PRE-SUBMI1TAL REC'D
MAY 3 0 2013 Page 8 of 16
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:
•
s14 a„s Date: _
Signatur
LgR2Y VAK IJ,ne/
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: •
1143 04 ( Date: 530_ /3
Signs e
LAR-P-7 LJ4,v 117.-7SN
Print
•
PRE-SUBMITTAL REC'D
MAY 3 0 2013
Page 9 of 16
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•
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
)9-02-7 -liTr-7oa eyMot [lrag' Kg- *Ili Zoe
•
TOTALS:
TOTAL NUMBER OF OWNERS IN THE PROPOSAL
NUMBER OF OWNERS WHO SIGNED
PERCENTAGE OF OWNERS WHO SIGNED
TOTAL ACREAGE IN:PROPOSAL
ACREAGE SIGNED FOR
PERCENTAGE OF ACREAGE SIGNED FOR
TOTAL VALUE IN THE PROPOSAL
VALUE CONSENTED FOR
PERCENTAGE OF VALUE CONSENTED FOR „
- PPE SURMI1TAL RECD —
MAY 3 .0 2013 13 of 16
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: ��1//-4121.7 VAN SEE-NEW
E-mail: of /J/u/&ja c aj Q COMG457-. HET
Supply the following information regarding the annexation area.
• Estimated Population (at present): /
• Number of.Existing Residential Units: /
• Other Uses: +�/�
• Land Area: /,Z Acmc total acres
• Existing Plan Designation(s):
• Existing Zoning(s):
• Existing Land Use(s):
• Applicable Comprehensive Plan(s):
• .Applicable Refinement Plan(s): •
•
• Provide evidence that the annexation is consistent with the applicable
comprehensive plan(s) and any associated refinement plans.
• Are there development plans associated with this proposed annexation?
Yes No
If yes, describe.
• 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).
•
PRE-BUBM!TTAL REC'D Page 14 of 16
MAY302013
• •
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
GI/Springfield School District • ❑ McKenzie Fire & Rescue
❑ Pleasant Hill RFPD IRI/Willakenzie RFPD
❑ EPUD �UB
C"Willamalane 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.
(Name) (Name)
(Address) (Address)
(City) (Zip) (City) (Zip)
(Name) (Name)
•
(Address) (Address)
(City) (Zip) (City) (Zip)
•
PRE-SUBMITTAL PECD
MAY 3 0 2013
Page 15of16
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ler
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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:
n-01-04-// —00700 5/076 Nogri STREET
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 Signa re Date Signed
LnRRy (244/ Q&ZNE7J ( a �e 5-30-/3
C/A/P7 U/FN FJEF.V�°N ' y�� 5 3 o-U
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PRE-SUBMITTAL REC'D
MAY 3 0 2013
WOG: L:TBCp008 BOUNCNANGE TRANSOTONLAPPLfGATION FORMS1SPRINGFTE LDTIO-03-08 UPDATED FORMS1PRE-SUBMITTAL ANNEXATION APPLICATION 10-07-08.000
Last Saved: October 27,2010
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