Application for ARSC

Page 1

Applicant

Date:

Owner

Agent

First Name:

Last Name:

Phone:

Cell Phone:

Fax:

Email:

Mailing List

Address:

City:

State:

Zip Code:

Is there a Co-Applicant?

Yes

Co-Applicant (If Necessary)

Month:

Year:

Owner

Agent

First Name:

Last Name:

Phone:

Cell Phone:

Fax:

Email:

Mailing List

Address:

City:

State:

Zip Code:

Page 2

Property Subject to Application

Address:

City:

State:

Zip Code:

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:

Uses Surrounding Subject Parcel

North:	West:
South:	East:

Page 3

Property owner(s)

*If different from applicants

Owner 1

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 2

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 3

Name:	Phone:
Address:	City:
State:	Zip Code:

Current list of adjoining and abutting property owners to the subject parcel obtained from the Mesa County Assessor\'s Office.

Owner 1

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 2

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 3

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 4

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 5

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 6

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 7

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 8

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 9

Name:	Phone:
Address:	City:
State:	Zip Code:

Owner 10

Name:	Phone:
Address:	City:
State:	Zip Code:

Page 4

Proposed Needs

Description of Proposed Utilities, Access and Other Infrastructure Needs:

Complete Incomplete

Comments:

The Application Shall Completely Address each of the Following Items:

Justification for annexation. Please clearly state the basis upon which the proposed annexation is made:

Complete Incomplete

Comments:

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:

Complete Incomplete

Comments:

By typing your name you are Authorizing an E-signature

Applicant Signature:

Date:

Applicant 2 Signature:

Date:

Annexation &, Resolution of Substantional Compliance

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TOWN HALL

ADDRESS

WELCOME