HomeMy WebLinkAboutApplication APPLICANT 1/28/2021City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
PERMIT REVIEW INTAKE FORM
SPRINGFlE D
(City Staff completes form)
Permit,.
Dept of Motor Vehicles -New: ❑
Land Use Compatibility Statement: X
City: X
Dept of Motor Vehicles -Renewal: ❑
Project Information
Zoning Verification Letter: ❑ UG6: ❑
Applicant Name: Joshua Fowler
Phone: 541-556-9779
Company:
Celh
Address: 3009 Teal Place, Eugene, OR 97404
Property Owner: Polen Development
Phone:
Company:
Cell;
Address: PO Box 71751, Springfield,
OR 97475
ASSESSOR'S MAP NO: 17032542
TAX LOT NOS : 01200
Pro er- -Address: 2 -155 -OI m-ic-Streeter-r-in fieldrOR-97477
Description of Proposal:OLCC LUCS for Retail Recreational Marijuana
Record Information
Record No: 811-21-000078-TYPS
Date ReceivedA/26/21
Application Fee: $343
Technical Fee: $17.15
TOTAL FEES: $360.15
Assigned Planner:L. Miller
Revised 11.2.11 k1
OREGON LIQUOR CONTROL COMMISSION REQUEST
MEME
NW Land Use Compatibility Statement
What is a land use compatibility statement (LUGS)? The LUCS is a form used by a state agency
and local government to determine whether a land use proposal is consistent with local govem-
ment'scomprehemive plan and land use regulations.
Why is a LUCS required? OLCC and other state agencies with permitting or approval activities that
affect land use are required by Oregon law to be consistent with local comprehensive plans and to
have a process for determining consistency. Section 34(4)(x) of 2015 Oregon Laws, Chapter 614,
requires OLCC to request and obtain the LUCS and have a positive LUGS prior to Issuing license.
CITY/COUNTY USE ONLY
pate delivered by license applicant
11.2y1Ll
Initial.
l'r
When Is a LUGS required? A LUCS Is required for all proposed marijuana facilities before an OLCC license can be obtained.
Have to complete a LUES:
• Step 1: Applicant completes Section 1 of this form and submits it to the appropriate city or county planning office. Applicant
verifies with local jurisdiction whether additional forms, applications, or permits are required.
• Step 2:LamIjurisdictloncompletesSection2ofthisformindicatingwhethertheproposeduseiscompatiblewiththeacknowl-
edged comprehensive plan and land use regulations and returns signed and dated form to the applicant.
• Applicant completes payment to local jurisdiction for processing application.
• Land jurisdictions are NOT mauimdto begin processing LUCS forms until January 4. 2016 at 8:30 AM.
• Step 3: Applicant submits this date-stamped form and any supporting information provided by the city or county to the OLCC
with the license application. This form may be submitted while Section
�2 is in process with the local governing body.
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Applicant Name: psL� Phone:
Mailing Address:al r� Rm/Ste:
City: g State: b ZIP: 4fi4o
❑ Site plan of the subject property and proposed development attached? (required)
ProposedRm/Ste:
Premises Address: �LiSS" Ot cC-+- '}}
City: S County: ® ZIP: 41V—
Tax Lot #•: Section 5—"I L�
Z Range )) lantnee:
Township': U— map*: 2 Lonsitada:
Proposed use/permit type sought (A separate LUCS maybe necessaryfor each proposed use even ¢it is an the same property):
® Producer E] Wholesaler ❑ Processor ®, Retailer laboratory [] Research Certificate
Note indoor or List endorse-
outdooluch. mens below
Details of proposed use jact. toy attactimens):
Q' INV5 mgvh(s log+ion
Section.2 — To be Completed by Local Jurisdiction
Site Location:
E Inside city limits ■ Inside UGB F1 Outside UGB
Name of Jurisdiction:
Property Zoning of
Proposed Premises:
❑ The proposed land use has been reviewed and is prohibited.
® The proposed land use has been reviewed and is not Prohibited.
7f the proposed land use is allowable only as a conditional use, permits are required as noted below.
mmmenn:
(s Silo. CtmplleS Lo(+I,, Ordinahu 05) or r'ef I
�QCr�u+i ono Mko l U6r)A- s*& . no other mord A n rti
USe iS `th'S S(
Name of Reviewing Local Official (print):
Title:
Date:
Email:
Phone:
Signature:
Check this box if there are attachments to this form:
El
Li Milifr
IQ
� h'1 i I (l ✓i I Or.
MMINC R Local' -funs ct+lons ars NOT req.Wedd to begin processing
Luh #6f " uritil jinuary 4.2oi6,it,8:30 ASR