HomeMy WebLinkAboutApplication APPLICANT 6/10/2008
City of Springfield
Development Services Department
225 Fifth Street
Springfield, OR 97477
Minimum Development Standards
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ASSESSOR'S MAP NO:
1-012..00
Address:
Acres D S uare Feet D
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Description of If you are filling In this form by hand, please attach your proposal description to this application
Pro osal:
Existin Use: /1-v'6-P-.rJ -{
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Associated Cases:
Case No.:
Date: Lt
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TOTAL FEES: $ 1'-'10. 2-S
lication Fee:
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PROJECT NUMBER:
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Date Received:
JUN 1 0 2008
ReVised 1/1/08 Molly Markarian
Original Submittal
1 of 6
FROM,:
FRX NO.
Ma~. 28 2008 10:20RM P3
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Owner:
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If the apphcant IS not the owner, the owner hereby grants permission for the applicant to act ~ his/hI' 1
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ation In thIs application ,s correct and accurat_-~
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Plot Plan
Preparation:
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I certifY that I prepared the attached plot plan and that it contains the Information speclfi 'In the ,~'
requirements checklist. I certify that the plot plan Is accurate based upon field locates an II:the be'"
available informatIon. I understcmd that City staff will rely upon the plot plan In making a ~ decls~ 'I.
regarding the Inlmum Development Standards application. I accept full responsibility an ~ihabllJt. r
event that th r a7 ~n~r :isslons, ml es, or Inaccuracies In the plot plan. ;!:
/0. uvi,4 Date: ,I
Plot P an Preparer Signature
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Original Submittal
Revised 1/1/08 Molly Markarian
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Minimum Development Standards Submittal Requirements Checklist
NOTE: If you feel an item does not apply, please state the reason why and attach the
explanation to this form.
D Application Fee - refer to the Development Code Fee Schedule for the appropriate fee
calculation formula. A copy of the fee schedule is available at the Development Services
Department. Any applicable application, technology, and postage fees are collected at the
pre-submittal and submittal stages.
D /Minimum Development Standards Application Form
D ./ Copy of the Deed
D
Copy ot a Preliminary Title Report issued within the past 30 days documenting
ownership and listing all encumbrances. I S Or~ ( ~) ~
Right-ot-Way Approach Permit Application provided where the property has frontage
on an Oregon Department of Transportation (ODOT) facility.
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D Detailed Written Explanation of the Proposal to Include:
Q,.ft... D Project name
D Size and location of property
D Zoning and plan designation of the site and adjacent properties
D Proposed use of the development area and scope of proposed development
D Access
D Proposed off-site improvements (i.e. installation of sidewalks, fire hydrants, sewer
main, etc.)
D Current use of the site and any existing improvements
D Special site features (i.e. wetlands, watercourses, steep slopes, etc.); a general
statement addressing soil type and drainage conditions
D Estimated quantities and type of materials Involved if any fill or excavation is proposed
D Number, type, and size of any trees to be removed
D Explanation of any land to be dedicated to the City
D Proposed modifications being requested
D Additional planning applications required for proposed project
D Justification for proposed MDS exceptions
D Time line extensions being requested
--t D ~ (5) Copies of a Plot Plan Including the Following Information:
D Proposed buildings and/or additions: location, dimensions, size (gross floor area),
setbacks from property lines, distance between builaings, and height
D The scale appropriate to the area involved and sufficient to show detail of the plan and
related data, such as 1" = 3D', 1" = 50' or 1" = 100'
D North arrow
D Date of preparation
D All existing and proposed easements
Revised 1/1/08 Molly Markanan
Date Received:
JUN 1 0 2008
4 of 6
Original Submittal
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
~ of Springfield Official Receipt
tt\elopment Services Department
Public Works Department
RECEIPT #:
2200800000000000860
Date: 06/10/2008
9:46:28AM
Job/Journal Number
DRC2008-00038
DRC2008-00038
Descnption
CTY Mmunum Dev Standards
+ 5% Technology Fee
Payments:
Type of Payment
CredltCard
PaId By
FM SHEET METAL INC
Item Total:
Check Number AuthonzatlOn
Received By Batch Number Number How ReceIved
emm 093498 In Person
Payment Total:
Amount Due
705 00
3525
$740.25
Amount Paid
$74025
$740.25
Date Received:
JUN \ 0 2008
original submitta\-
cRecemtl
Page I of 1
6/1 0/2008
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First American
First American Title Insurance Company of Oregon
600 Country Club Road
Eugene, OR 97401
Phn - (541)484-2900
fax - (541)484-7321
FOR ALL OUESTIONS REGARDING THIS PRELIMINARY REPORT. PLEASE CONTACT:
Marcia Lind, Title Officer
Phone: (541)484-2900 - Fax: (541)484-7321 - Email: mllnd@firstam.com
FM Enterpnses
2422 Main Street
Springfield, OR 97477
Order No.: 7199-1242337
June 09, 2008
Attn:
Phone No.: (541)726-3000 - Fax No.:
Emall:
Re:
Preliminary Title Report
ALTA Owners Standard Coverage liability $ Premium $
ALTA Owners Extended Coverage Liability $ Premium $
ALTA Lenders Standard Coverage Liability $ Premium $
ALTA Lenders Extended Coverage liability $ Premium $
Endorsement Premium $
Govt Service Charge Cost $
Other Report Only Cost $ 200,00
We are prepared to Issue Title Insurance Policy or Policies in the form and amount shown above, Insunng
title to the following descnbed land:
The land referred to In this report IS descnbed In Exhibit A attached hereto.
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and as of June 03, 2008 at 8:00 a.m., title vested In:
,
,
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Knsty L. Fitzgerald
I
Subject to the exceptions, excluslons, and stipulations which are ordlnanly part of such Policy form and
the following:
1.
The nghts of the public In and to that portion of the premises herein deScribed lYing Within the
limits of streets, roads and highways.
Date Received:
JUN 1 0 2008
Oriainal submittal
This report IS for the exclusive use of the parties herein shown and IS preliminary to the Issuance'Bf a
title Insurance policy and shall become VOid unless a policy IS Issued, and the full premium paid
Preliminary Report
Order No 7199-1242337
Page 2 of 4
2. Easement, including terms and provIsions contained therein:
Recording Information: June 25, 1947 In Book 340, Page 288
In Favor of: Mountain States Power Company
For: nght of way
3. Easement, including terms and provIsions contained therein:
Recording Information: June 18, 1949 In Book 397, Page 263
In Favor of: City of Spnngfleld, a Municipal Corporation, of Lane County,
State of Oregon
For: sewer
,
4. Lease and the terms and conditions thereof:
Lessor:
Lessee:
As disclosed by:
Dated:
Recorded:
Recording No.:
Dorothy M. Slavens
Jack Nasholm and Virginia B. Nasholm
Memorandum of Lease
ApnlOl,1966
May 27, 1971
48412
- END OF EXCEPTIONS -
NOTE: Taxes for the year 2007-2008 PAID IN FULL
Tax Amount: $1,848.29
MaplJo.: 1703364101200
Property ID: 0332559
Tax Code No.: 01900
SituS Address as disclosed on Lane County Tax Roll:
2422 Main Street, Spnngfield, OR ~7477
THANK YOU FOR CHOOSING FIRST AMERICAN TITLE!
WE KNOW YOU HAVE A CHOICE!
cc:
cc: Knsty Fitzgerald
Date Received:
JUN 1 0 2008
Original Submittal
Arst Amencan Title
Preliminary Report
Order No.. 7199-1242337
Page 3 of 4
First American Title Insurance Company of Oregon
SCHEDULE OF EXCLUSIONS FROM COVERAGE
ALTA LOAN POLICY (06/17/06)
The following matters are expressly excluded from the coverage of this policy, and the Company will not pay loss or damage, costs, attorneys' fees, or
expenses that arise by reason of
1 (a) Any law, ordinance, permit, or governmental regulatron (including those relating to bUilding and zOning) restricting, regulating, prohibiting, or
relating to
(I) the occupancy, use, or enjoyment of the Land,
(II) the character, dimensions, or location of any Improvement erected on the Land,
(III) the subdiVISion of land, or
(IV) environmental protection,
or the effect of any Violation of these laws, ordinances, or governmental regulations This Exclusion l(a) does not modify or limit the coverage
prOVided under Covered Risk 5
(b) Any governmental police power This Exclusion l(b) does not modify or limit the coverage prOVided under Covered Risk 6
2 Rights of eminent domain This Exclusion does not modify or limit the coverage prOVided under Covered Risk 7 or 8
3 Defects, liens, encumbrances, adverse claims, or other matters
(a) created, suffered, assumed, or agreed to by the Insured Claimant,
(b) not Known to the Company, not recorded In the Public Records at Date of Policy, but Known to the Insured Claimant and not disclosed In writing to
the Company by the Insured Claimant prior to the date the Insured Claimant became an Insured under this policy,
(c) resulting In no loss or damage to the Insured Claimant,
(d) attaching or created subsequent to Date of Policy (however, this does not modify or limit the coverage proVided under Covered Risk 11, 13, or 14),
or
(e) resulting In loss or damage that would not have been sustained If the Insured Claimant had paid value for the Insured Mortgage
4 Unenforceablllty of the lien of the Insured Mortgage because of the inability or failure of an Insured to comply With applicable dOing-bUSiness laws of the
state where the Land IS situated
5 Invalidity or unenforceablllty In whole or In part of the lien of the Insured Mortgage that arises out of the transaction eVidenced by the Insured Mortgage
and IS based upon usury or any consumer credit protection or truth-In-Iendlng law
6 Any claim, by reason of the operation of federal bankruptcy, state Insolvency, or Similar creditors' rights laws, that the transaction creating the lien of the
Insured Mortgage, IS
(a) a fraudulent conveyance or fraudulent transfer, or
(b) a preferential transfer for any reason not stated In Covered Risk 13(b) of this policy
7 Any lien on the Title for real estate taxes or assessments Imposed by governmental authOrity and created or attaching between Date of Policy and the
date of recording of the Insured Mortgage In the Public Records This Exclusion does not modify or limit the coverage proVided under Covered Risk l1(b)
ALTA OWNER'S POLICY (06/17/06)
The following matters are expressly excluded from the coverage of this policy, and the Company will not pay loss or damage, costs, attorneys' fees, or
expenses that arise by reason of
(a) Any law, ordinance, permit, or governmental regulation (including those relating to bUilding and zoning) restricting, regulating, prohibiting, or
relating to
(I) the occupancy, use, or enjoyment of the Land,
(II) the character, dimenSions, or location of any Improvement erected on the Land,
(III) the subdiVISion of land, or
(IV) environmental protection,
or the effect of any Violation of these laws, ordinances, or governmental regulations This ExclUSion l(a) does not modify or limit the coverage proVided
under Covered Risk 5
(b) Any governmental police power This ExclUSion l(b) does not modify or limit the coverage prOVided under Covered Risk 6
2 Rights of eminent domain This ExclUSion does not modify or limit the coverage proVided under Covered Risk 7 or 8
3 Defects, liens, encumbrances, adverse claims, or other matters
(a) created, suffered, assumed, or agreed to by the Insured Claimant,
(b) not Known to the Company, not recorded In the Public Records at Date of Policy, but Known to the Insured Claimant and not disclosed In writing to
the Company by the Insured Claimant prior to the date the Insured Claimant became an Insured under this policy,
(c) resulting In no loss or damage to the Insured Claimant,
(d) attaching or created subsequent to Date of Policy (however, this does not modify or limit the coverage prOVided under Covered RISks 9 and 10), or
(e) resulting In loss or damage that would not have been sustained If the Insured Claimant had paid value for the Title
4 Any claim, by reason of the operation of federal bankruptcy, state Insolvency, or Similar creditors' rights laws, that the transaction vesting the Title as
shown In Schedule A, IS
(a) a fraudulent conveyance or fraudulent transfer, or
(b) a preferential transfer for any reason not stated In Covered Risk 9 of this policy
5 Any lien on the Title for real estate taxes or assessments Imposed by governmental authOrity and created or attaching between Date of Policy and the
date of recording of the deed or other Instrument of transfer In the Public Records that vests Title as shown In Schedule A
SCHEDULE OF STANDARD EXCEPTIONS
2
The lien of Real Estate Taxes or Assessments Imposed on the title by a governmental authOrity that are not shown as
eXisting liens In the records of any taxing authOrity that leVies taxes or assessments on real property or In the public
records
Any Facts, Rights, Interests, or Claims that are not shown In the public records but that could be ascertained by an
Inspection of the land or by making InqUiry of persons In possession of the land
Easements, Claims of Easements or Encumbrances that are not shown In the public records
Any Encroachment, Encumbrance, Violation, Variation, or Adverse Circumstance affecting the title including
discrepancies, conflicts In boundary lines, shortage In area, or any other facts that would be disclosed by an accurate and
complete land survey of the land, and that are not shown In the public records
Unpatented MIning Claims, Reservations or Exceptions In Patents or In acts authOriZing the Issuance thereof, Water
Rights, Claims or Title to Water
Any lien, or Right to a lien, for Services, Labor or Material theretofore or hereafter furnished, Imposed by law and not
shown In the public records
Date Rg~~i\lQn'
11 149 Rev 6-17-06
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4
5
6.
NOTE A SPECIMEN COPY OF THE POliCY FORM (OR FORMS) WILL BE FURNISHED UPON REQUEST
JUN 1 0 2008
Arst Amencan Title
Original submittal
Preliminary Report
,-
Exhibit "A"
Real property In the County of Lane, State of Oregon, descnbed as follows:
Order No 7199-1242337
Page 4 of 4
BEGINNING AT A POINT ON THE NORTH RIGHT OF WAY UNE OF THE MCKENZIE HIGHWAY 835.0 FEET
NORTH 890 44' WEST OF A POINT 49.0 FEET NORTH 000 06' WEST FROM THE SOUTHEAST CORNER OF
THE JAMES A. EBBERT DONATION LAND CLAIM NO. 74, TOWNSHIP 17 SOUTH, RANGE 3 WEST OF THE
WILLAMETTE MERIDIAN; THENCE ALONG SAID NORTH RIGHT OF WAY LINE NORTH 890 44' WEST 60.0
FEET; THENCE NORTH 000 06' WEST 99 FEET; THENCE NORTH 890 44' WEST 50 FEET; THENCE NORTH
00006' WEST 106 FEET TO THE SOUTH RIGHT OF WAY LINE OF NORTH 'A' STREET; THENCE ALONG
THE SAID SOUTH RIGHT OF WAY LINE SOUTH 89044' EAST 110 FEET; THENCE SOUTH 000 06' EAST
205 FEET TO THE POINT OF BEGINNING, IN LANE COUNTY, OREGON.
Tax Parcel Number: 0332559
Arst Amencan Title
Date Received:
JUN 1 0 2008
Original Submittal
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THIS MAP IS PROVIDED AS A COURTESY
BY FIRST AMERICAN TITLE INSURANCE
COMPANY OF OREGON TO ASSIST IN
LOCA TING SAID PREMISES AND THE
COMPANY ASSUMES NO LIABILITY FOR
ITS ACCURACY OR FOR MA TIERS THAT
MA Y BE DISCLOSED BY A SURVEY
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Department of
Transportation
.APPLICATION FOR STATE HIGHWAY APPROACH
Required Infonnation
The applicant must submit the following Information with the Application for State Highway Approach. OOOT will notify
the applicant If additional information is required
. All attachments reqUired by answers on the appll~tlon form, including applicant signature
. If the applicant IS not the owner of the property to be served by the approach, then the property owner must authorize
the applicant as a designated agent. The applicant must have the property owner complete the AuthorizatIon of
Designated Agent block on this form OR submit a Signed letter from the property owner authorizing the applicant as
the deSignated agent
. Site plan and VICInity map approved or currently being reViewed by the local government
. A Land Use CompatIbility Statement (LUCS) for a State Highway Approach (page 4 of this application) must be
completed by the local government.
D A copy of the current County tax lot map for the property served by the approach. Map must highlight all property that
would be served by the approach and list all owner name(s) on adjacent properties Make a note on map If ownership
of adjacent property IS same as subject property. Identify the location of the proposed approach on map.
. A copy of the recorded easement(s), If the subject property has an eXisting easement(s) for access to the property
. A copy of any eXisting state or local government approach permits for the property.
In addition to the above submittals, the applicant may be reqUired to place stakes or markings near the highway shoulder
at the proposed approach location.
Defimtions for commonly used terms are In the attached brochure The brochure is also available on the OOOT webslte
located at http Ilwww oreQon Qov/OOOT/HWY/ACCESSMGTI
HIghway name - May be a statewide highway name, such as PaCific Highway, or a local name, such as East Main Street
Route name - Th~ ~osted highway number, such as 1-5 or US-84.
Highway name. tIff' N S1- Route number County 4NF
Mllepoint 2,/,:2.. (f1k,~ srSlde of highway. ~orth 0 South 0 East 0 West
Is the highway In a national forest area? 0 Yes IDo
H rlc)'i
--
Date R~ceived:
734.2680 (9/07)
Page 1 of4
JUN 1 0 2008
Original Submittal
..Y<!> _w ~ <:-
,>~~Q1i:~
~'?~'} ~:R~ERTY OVMER
to represent me In the matter of this hIghway approach permit application
Owner signature' X
NOTIFICATION TO APPLICANT The ODOT Distnct Office Will contact you when your applicatiMi~~bmitwited.Jf -
additional documents are required to continue the application process you will be notified. When all of the necessary
documents have been received, the application Will be deemed complete If your completed application IS approved,
preliminary construction speCIfications will be Issued. A performance bond and liability Insurance will be required before any
construction work can begin on the highway nght of way. For the complete rules regarding approach permitting, see OAR
Chapter 734 Division 51
The Applicant declares, certifies, and affirms under penalty of app/i a Ie stflte or fedel1 I laws that all information
provided on this form and attachments are true and complete t est his e kn wledge.
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New Approach _ There IS no existing permItted or grandfathered approach road at the location requested In thIs
application.
Temporary Approach - The approach requested Will be removed after a speCIfied penod of time
ExIsting Approach - This application affects, or may affect, an eXisting approach.
o Restricted Use Approach - The approach requested IS for emergency services, government, utility access or SImilar
speCific uses With limIted traffic
~ienl~l~~tJ;irniii'f~.
Tum movements requested. 0 All OR check all that apply' 0 Right 0 Right out 0 Left In 0 Left out
State'
Fax '2J?/-
Are there additional owners of the subject property? 0 Yes No
If Yes, attach the same contact Information as above for each of the co-owners on a separate sheet
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ZIP' "7 If'J'''
SectJon(s)
bl ,j p Proposed zoning:' R-
e existing and proposed land use(s) on the property, including s uare footage or acreage.
EXlstlng~ I~G p~_ r~ f,J If:r fAJ-C" D A:s Proposed (QI{ ""/ IiV/S-IUJ b~~ ~b)
If 11hA-~..N t.J:Tk} lfPN?r:J- ,"'-\-fJ1t!-.--y Uoo~ 5it~ f1-- INn ~ Ot..b ~~)~~~
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~I N UN tA~~D AT 7J..J IS TI'1,G.
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(, 'Wif~ "'~ *J"~' -::"l
If the local govemment has approved a site plan or IS currently reviewing a plan for the proposed land use, then skip this
page and attach a copy of those plans Otherwise, draw and label a site plan indlcatmg all applicable mformatlon listed
below You may use the space provided or another sheet no larger than 11" x 17"
. Place arrow In box below to indicate direction of north for site sketch orientation.
. Show dIstances related to access and on-sIte cIrculation. Include distance from property lines to the center of
proposed approach.
. Show all lots or parcels that are part of the property, and their corresponding tax lot number(s).
. Usmg solid hnes Indicate proposed approaches, bUlldmgs, structures, equipment and other facIlities.
. USing dashed lines mdlcate existing approaches, bUildings, structures, equipment and other facilities and easements
Note any eXlstmg Approach Road permits to the property
. Note nearest landmark or cross street, and distance and direction from the requested approach location.
. Show local streets abutttng the property, the locatIon of the edge of pavement of the highway, and locatIon and layout
of parkmg areas showing connections to eXlstmg drrveways
. Include location and distance measured from centerline of approach to nearest approach roads on both Sides of the
highway for at least 500 feet Please mdlcate the Width, land use category, and turning movements of all
approaches.
. Place an "X" across eXisting approaches to be closed.
~
Date Received:
JUN 1 0 2008
Original Submittal
734-26BO (9/07)
Page 3of4
.
DATE RECEIVED BY ODOT'
CHAMPS IDtt
]~regon
Departmental
Transportation
LAND USE COMPATIBILITY STATEMENT (LUeS)
What is a LUeS? A Land Use Compatibility Statement (LUCS) is the form ODOT uses to ensure that Highway Approach
Permits are consistent with local land use requirements
Why is a LUeS Required? ODOT Coordination Rules, OAR 731-015, Identify Highway Approach Permits as permits that
affect land use State law reqUires ODOT actiVIties that affect land use to be consistent with acknowledged local
comprehensive plans
When is a LUCS Required? An ODOT LUCS must be submitted with every ODOT Highway Approach Permit
Application
How to Complete the LUCS: The applicant completes Section 1 Section 2 must be completed by the local Junsdictlon.
The applicant then submits the completed LUCS to ODOT as part of the Highway Approach PermIt Application
:;f
) -61 Ul'O
Section 2 must be completed by a Local Planning Official.
"",,","$ ,,;C<l
;5 €T,j
*:-0
The subject property IS ISQlnslde City limits 0 Outside, city II ts 0 Inside UGB 0 OKtslde UGB ,\.0
Current Comprehensive Plan deSignation: G ()'Y\fl1. Current zOning Cotv\fhLU1, "^-
Is a Comprehensive Plan or zoning amendment proposed? Yes No
If yes, list the proposed plan deSignation Proposed zoning.
Does the actiVity, use, or development require land use review to determine compliance With regulations? IMrYes 0 No
If no, It means that no local land use review IS required SkIp to Local P1annmg Official Information section below.
If yes, what IS the status of the land use application? 0 Approved 0 Denied lRl' Under review 0 Not yet received
List file numbers -=t)t1 J.CJ> 'b -~( Is the deciSion final? 0 Yes ~No
Comments
734-26BO (9/07)
Page 4 of 4
'M~~/IO tt
JUN 1 0 2008
Planning offiCial signature
Original submittal
"
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II" ~:i;porta6on
APPLICATION FOR STATE HIGHWAY APPROACH
Required Information
The applicant must submit the following information with the Application for State Highway Approach OOOT will notify
the applicant If additional information IS required
. All attachments required by answers on the application form, Including applicant signature
. If the applicant IS not the owner of the property to be served by the approach, then the property owner must authonze
the applicant as a designated agent The applicant must have the property owner complete the Authonzatlon of
Designated Agent block on this form OR submit a signed letter from the property owner authonzlng the applicant as
the designated agent
. SIte plan and vicInity map approved or currently being reviewed by the local government
. A Land Use Compatibility Statement (LUCS) for a State Highway Approach (page 4 of this application) must be
completed by the local government.
. A copy of the current County tax lot map for the property served by the approach Map must highlight all property that
would be served by the approach and list all owner name(s) on adjacent properties Make a note on map If ownership
of adjacent property IS same as subject property Identify the location of the proposed approach on map
. A copy of the recorded easement(s), If the subject property has an eXisting easement(s) for access to the property
. A copy of any eXisting state or local government approach permits for the property
In addition to the above submittals, the applicant may be reqUired to place stakes or markmgs near the highway shoulder
at the proposed approach location
Definitions for commonly used terms are In the attached brochure The brochure IS also available on the OOOT webslte
located at. http Ilwww oreqon qov/OOOT/HWY/ACCESSMGTI
J!-rCJi
-
Highway name - May be a statewide highway name, such as PaCific Highway, or a local name, such as East Main Street
Route name - The posted highway number, such as 1-5 or US-84
Highway name iIR-, to( S-- Route number' County 4NF
Mllepolnt 2.,/,-"2.. fY1kl~ srSlde of highway E]"N'orth D South D East D West
Is the highway In a national forest area? DYes IDo
Date Received:
734.2680 (9/07)
Page 1 of4
JUN 1 0 2008
Original Submittal
06/09/2008 13 40 FAX
CarSport
@003
NOTlACATlON TO AP . OOOT DIstrict Office wiD cordad you when your application has been reviewed. If
addiUonaI doaunents are required to conUnue the appUcaUon process you will be notified. \M1en aU of the necessary
documents have been received, the appHcation wiD be deemed compJete. If your completed appIlcaUon ~ approved,
prelImInary construction specifications will be Issued. A performance band and liability Insurance win be required before any
construction work can begin on the highway right of way. For the complete rules regarding approach pennlWng, S88 OAR
Chapter 734 DIvIsion 51.
The Applicant declares. cetfHies, and Bfflrms under penalty of 8ppIiJ
provided on this fonn and llItachments are true and complete
Print name: rrctl ~
New Approach - There is no existing permitted or grandfatheled approach road at the location requested In this
appllcaUon.
Temporal)' Approach - The approach requested will be removed after a specified period of time.
Existing Approach - This appncation affects, or may affect, an existing approach ,
Restrtcted Use Approach - The approach requested is for emergency services, govemment, UlIIIty access or similar
specific uses with nmited traffic.
Last name: ,
Street address:
City:
Mailing add
City:
Phone: '2J?/- foCi
E-maD:
Are there addItional owners of the subject property? (' 0 Yes No
If Yes, attach the same contact Information as above for each of the co-owners on a separate sheel
- -
Current zoning:
In the boxes below, describe
ExISling:.-,-m- fk4~~ tJ~ ~D ~
If iii tA-1UJ Lknt )1P,/f'o:J. '~7fII."''1 U~
6 A R.fH:Hfr~A ~H~ p ,,1Ft- ApPb)l,~
r/{~t.lr AH.. ~ 1"'-nJi:"~4
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OfA: {;A. 2..~1-L -tNb 6t& r;;-~ 2.1./~(1
N Pp,J .3t7
~\!G- JlfJ.b /{PPIlOlrlJ/F-.[ ,WILL
~IIJ u,.,~~ ArvP"IS T'n,&:
Date Received:
JUN 1 0 2008
Original Submittal '
1"71:", -hlll~ t<'/v ~- ~
,.~C.~l~_"~~P!iL'~w,
If the local government has approved a Site plan or is currently reviewing a plan for the proposed land use, then skip this
page and attach a copy of those plans Otherwise, draw and label a Site plan indicating all applicable InformatIon listed
below You may use the space provided or another sheet no larger than 11" x 17"
o Place arrow In box below to indicate direction of north for site sketch orientation
. Show distances related to access and on-site cIrculation Include distance from property lines to the center of
proposed approach
. Show all lots or parcels that are part of the property, and their corresponding tax lot number(s).
. USing solid lines Indicate proposed approaches, buildings, structures, equipment and other facIlities
. USing dashed lines indicate eXisting approaches, bUildings, structures, eqUipment and other faCIlities and easements
Note any eXisting Approach Road permits to the property
. Note nearest landmark or cross street, and distance and direction from the requested approach location
II Show local streets abutting the property, the location of the edge of pavement of the highway, and location and layout
of parking areas shOWing connections to eXisting driveways.
. Include location and distance measured from centerline of approach to nearest approach roads on both Sides of the
highway for at least 500 feet. Please Indicate the Width, land use category, and turning movements of all
approaches
. Place an "X" across eXisting approaches to be closed
~
Date Received:
JUN 1 0 2008
Original Submittal
734-2680 (9/07)
Page 3 of4
DATE RECEIVED BY ODOT
CHAMPS ID#
]f2'1TJfJOn
Department of
TransportaUon
LAND USE COMPATIBILITY STATEMENT (LUCS)
What is a LUeS? A Land Use Compatibility Statement (LUCS) IS the form ODOT uses to ensure that Highway Approach
Permits are consistent with local land use requirements
Why is a LUeS Required? ODOT Coordination Rules, OAR 731-015, Identify Highway Approach Permits as permits that
affect land use State law requires ODOT activities that affect land use to be consistent with acknowledged local
comprehensive plans
When is a Lues Required? An ODOT LUCS must be submitted with every ODOT Highway Approach Permit
Application
How to Complete the LUeS: The applicant completes Section 1 Section 2 must be completed by the local JUriSdiction
The applicant then submits the completed LUCS to ODOT as part of the Highway Approach Permit Application
Applicant name
Section 2 must be completed by a Local Planning Official.
:sE6ito ;;, . ;~'
..~ 't>" -,t" _I; ~ '* y '>>=' 'i1~ ,.~,,,
The subject property IS nSlde City IIm'ts 0 Outside city limits 0 Inside UGB Do tSlde UGB
Current Comprehensive Plan design~tlon' t~ ) fiJ.-... Current zOning f Wl(hUflrL
Is a Comprehensive Plan or zOning amendment proposed? 0 Yes No
If yes, list the proposed plan designation: Proposed zOning
Does the activity, use, or development require land use review to determine compliance with regulations? ~Yes 0 No
If no, It means that no local land use review IS required SkIp to Local Plannmg Official Information sectIon below
If yes, what IS the status of the land use application? 0 Approved 0 Denied ~nder review 0 Not yet received
list file numbers l)/LL J.oO~ .., bo~ t Is the deCISion final? 0 Yes ~o
Comments
I ann lr-
Planning official signature X
( I DI d r
734-26BO (9/07)
Page 4 of 4
JUN 1 0 2008
Original Submjttal__=~:d_~
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Original Submittal
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Original Submittal
SITE
Map 17-03-36-41
Tax Lot 1200
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