HomeMy WebLinkAboutApplication APPLICANT 3/9/2021City of Springfield A
Development & Public Works L
225 Fifth Street
Springfield, OR 97477
Annexation Development Issues Meeting (DIM)
SPRINGFIELD
D
Required Project Information (Applicant:
complete this section)
Prospective Daryl and Patty Brisco
30088, 229D9
601
Applicant Name:
Phone:
Company:
Fax:
4012 Jasper Road, Springfield, OR, 97478
Address: 1>e 9
l corn
E-mail: plbriiscn@gmaimwrn
Prospective
Applicant's Rep.:
Phone:
Company:
Fax:
Address:
E-mail:
Property Owner: Daryl and PattyBrisco
54:514�9
Phone: 11 .s01
Company:
Fax:
daryl. brisco@gmail.com
Address: 4012 Jasper Road, Springfield, OR, 97478
E-mail: plbrism@gmail.com
ASSESSOR'S MAP NO. 16-02-06-14-07700
TAX LOT NOS : 18-02-06-14-07700
Property Address: 4012 Jasper Road, Springfield, OR, 97478
Size of Property: 0.22 Acres ® Square Feet ❑
Description of If you are filling in this form by hand, please attach your proposal description to this application.
Proposal: Annexation into the city of Springfield for the purpose of connecting to city sewer.
Existing Use: Residential 7001 Pro osed Use: Residential 1001
ow is
M -Medium Density Residential
Cit Zonin ; None Found
Metro Designation:
Population:
Prospective 3 -S-
Applicant: Date: , '�--/
gnature
bV'+5CO
h.
L
Print /
Required Project
Case No.: I Date: Reviewed by:
Application Fee: $
Technical Fee: 0
1 Postage Fee: 0
TOTAL FEES:$ PROJECT NUMBER:
Reyised 4/8/14 W 6 of 17