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HomeMy WebLinkAboutApplication APPLICANT 6/23/2022City of Springfield Development & Public Works 225 Fifth Street Springfield, OR 97477 0 Annexation Application Type IV IL 6 Type (Applicant: Check one) lApplication Annexation Application lication Pre -Submittal: ❑ Annexation A lication Submittal: Required Proposal Information , =P f'' 1 Property Owner: L 0 (Applicant: Complete Phone: This Section) 55 -932 9 Address: -3• /' Fax: E-mail: Ccfefd� Owner Signature: // -,,Cf xq e 1, 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: 115 -oz- Db - Iy TAX LOT NOS %*919- 'B9 00 Property Address: 952 5 04A /ata - Area of Re nest: Acres: O •20 Square Feet: Existing Use(s) iA N of Property: Proposed Use V'eEs:D�,Ac- -wee-� ,r4c, of Property: Required Property Information (City Intake Case No.: - Date: `6)l-zz -00015-1_Typq Staff., Complete This Section) 6 Reviewed By: ��3/2ou initials Application Fee: I Postage Fee: 65$ trU Total Fee: Revised 4/8/14 B] Page 8 of 17 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. "n to / Date: Sl Print 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. h ( � _/ 2me__ tM7_V _ Revised 4/8/14 BI Page 9 of 17 � 2-\ � } � x ! \}7 . \ /\ § )) \} � ƒ- \ \S 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 IS -oz -Db -)y -o8 C-LETrE-rgpj-,-rr o.z 16o,319 Y TOTAL VALUE IN THE PROPOSAL x&0 -31q VALUE CONSENTED FOR PERCENTAGE OF VALUE CONSENTED FOR /Q TOTALS: D,7- I6o,319 TOTAL NUMBER OF OWNERS IN THE PROPOSAL NUMBER OF OWNERS WHO SIGNED PERCENTAGE OF OWNERS WHO SIGNED .an TOTAL ACREAGE IN PROPOSAL 0,2 - 2,ACREAGE ACREAGE SIGNED FOR 0, 2� PERCENTAGE OF ACREAGE SIGNED FOR av TOTAL VALUE IN THE PROPOSAL x&0 -31q VALUE CONSENTED FOR PERCENTAGE OF VALUE CONSENTED FOR /Q Revised 4/8/14 133 14 of 17 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 11 Eugene School District 13 Pleasant Hill School District N' Springfield School District ❑ McKenzie Fire & Rescue ❑ Pleasant Hill RFPD 1Ir�Willakenzie RFPD ❑ EEPUD a SUB [I' 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) (City) (zip) (Name) (Address) (City) (Zip) Revised 4/8/14 BI Page 16 of 17 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 'oonnaaddditional sheets.) Contact /��/6Person: C,7J- G E-mail: �!f1 f f 03a, a AlaiOm Supply the following information regarding the annexation area. • Estimated Population (at present): • Number of Existing Residential Units: • Other Uses: nye • Land Area: total acres / • Existing Plan Designation(s): __06( .i ` • ExistingZoning(s): D renes &9 Qr • Existing Land Use(s): )fe 5jICC • Applicable Comprehensive Plan(s): 5�> �j�ld 2030 e,,,,e,,,i„nc;vc Pl&' • Applicable Refinement Plan(s): • Provide evidence that the annexation is consistent with the applicable comprehensive plants) and any associated refinement plans. • Are there development plans associated with this proposed annexation? Yes / No If yes, describe. Conneriion }o G'i-.4 sa pA'e sus% • 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). 1 W.N1 ho (nnT�n,.n�.e to onr__ri,'- _+ aylry Gi " Revised 4/8/14 67 Page 15 of 17