HomeMy WebLinkAboutApplication APPLICANT 3/18/2022City of Springfield
Development & Public Works
225 Fifth Street
Springfield, OR 97477
Annexation Application Type IV
3 SPNINOFI
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Application Type
(Applicant.
Check one)
a
Annexation Application Pre -Submittal:
Annexation Application Submittal: ❑
Required Proposal Information (Applicant.,
Property Owner: leout i7-? . `A m h (-o g % 0
Complete
Phone:
This Section)
5V-.23)-3jp
Address:
Fax:
u/ 3 23
E-mail:
louiseo/a1)2 ms;
Owner Signature:
ohnal
Owner Signature:
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 the owner of record are required, only the owner may sign the petition.
ASSESSOR'S MAP NO:
-Q -22_
TAX LOT
NOS :�
Property Address:
I T-N-nki's
Area of Re nest:
Acres:
Square Feet:
Existing Use(s)
4x��..kv
of Property:
Proposed Use
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of Property:
Required Property Information (City Intake Staff., Complete
Case No.: %II-Z-L-ODooj-I-PQC Date:3 / 1612J22
This Section)
Reviewed By:
initials
Application Fee: 1649,
0-0 1 Postage Fee:
Total Fee:
b4
Revised 4/8/14 B] Page 8 of 17
179
/1(76"7
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.
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.
Date:
na r
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.
Date:
Signature
Revised 4/8/14 133 Page 9 of 17
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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
(Map/lot number)
Name of Owner
Acres
Assessed
Value
Imp.
Y/ N
Signed
Yes
Signed
No
{7-03`3'1 �"1-2-mz/
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t 00o(a
TOTAL VALUE IN THE PROPOSAL
-r34/ /Z
VALUE CONSENTED FOR
3tf/ -7/.Z
PERCENTAGE OF VALUE CONSENTED FOR
hobo u
TOTALS:
TOTAL NUMBER OF OWNERS IN THE PROPOSAL
2 -
NUMBER
NUMBER OF OWNERS WHO SIGNED
Z
PERCENTAGE OF OWNERS WHO SIGNED
I cc)
TOTAL ACREAGE IN PROPOSAL
p ,�
ACREAGE SIGNED FOR
n.Z6-�
PERCENTAGE OF ACREAGE SIGNED FOR
t 00o(a
TOTAL VALUE IN THE PROPOSAL
-r34/ /Z
VALUE CONSENTED FOR
3tf/ -7/.Z
PERCENTAGE OF VALUE CONSENTED FOR
hobo u
Revised 4/8/14 B) 14 of 17
FORM 3
SUPPLEMENTAL INFORMATION FORM
(Complete a// 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.)
L� L -t(_ -5e � 1 7
Contact Person: �(Yy1Y>VrD.SI vII
E-mail: t tll --5(fa MInr�0� 11) ® heA-G-I I _cob #K -
Supply the following information regarding the annexation area.
• Estimated Population (at present): —7
• Number of Existing Residential Units: I
• Other Uses:
• Land Area: () U total acres
• Existing Plan Designation(s):
• Existing Zoning(s): LD
• Existing Land Use(s): LbR_ // t— 11 /�
• Applicable Comprehensive Plan(s): Me�'ro '151g,9�an 1 1rlati2.lid l DmP•PIAn
• 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 o'�Jdevelopment allowed on the property under the current
plan designation and zoning?
Yes J No
Please describe where the proposed annexation is contiguous to the city limits
(non-contiguous annexations cannot be approved under 5.7-140, Criteria).
Does this application include all contiguous property under the same ownership?
Yes ✓plNo
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 5KRainbow Water and Fire District
❑ Eugene School District ElPleasant Hill School District
hY/Springfield School District ❑ McKenzie Fire & Rescue
❑ Pleasant Hill RFPD ❑ Willakenzie RFPD
❑EPUD 13SUB
Ci"/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)
(Address)
(City) (zip)
(Name)
(Address)
(City) (zip)
(Name)
(Address)
(Name)
(Address)
(City) (ZIP)
Revised 4/8/14 133 Page 16 of 17