Date:
First Name:
Last Name:
Phone:
Cell Phone:
Fax:
Email:
Mailing List
Address:
City:
State:
Zip Code:
Is there a Co-Applicant?
Month:
Year:
Parcel #:
Existing Zoning:
Acreage or Square Feet Parcel:
Surrounding Zoning
North:
West:
South:
East:
Practical Property Description:
Legal Description:
Description of Annexation Request:
Present Use of Subject Property:
Owner 1
Name:
Owner 2
Owner 3
Owner 4
Owner 5
Owner 6
Owner 7
Owner 8
Owner 9
Owner 10
Description of Proposed Utilities, Access and Other Infrastructure Needs:
Comments:
Justification for annexation. Please clearly state the basis upon which the proposed annexation is made:
Designation of the Property in the DeBeque Comprehensive Plan. Identify the applicable classifications or descriptions of the property and recommendations for use, density or other requirements specified in the DeBeque Comprehensive Plan:
Applicant Signature:
Applicant 2 Signature:
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