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Written Statement (Submit 5 copies) <br />❑ Submit a detailed written statement describing- this request is consistent with all applicable criteria <br />(Section 9.7825 of the Eugene Code). <br />Site Plan Requirements <br />Submit 8 copies of a site plan, drawn to an engineer's scale on 8 %" x 14" sheet of paper. Site plans shall include the <br />following information: <br />❑ Show the date & north arrow on site plan. <br />❑ Show the Assessor's Map and Tax Lot number(s) on the site plan. <br />❑ Show a vicinity map on the site plan (vicinity map does not need to be to scale). . <br />❑ Show city limits & UGB (if applicable) <br />❑ Clearly label the affected territory and any public right of ways to be annexed. <br />❑ Show all adjacent streets, alleys, and accessways. <br />❑ Show all dimensions of existing public utility easements and any other areas restricting use of the parcels, such <br />as conservation areas, slope easements, access easements, etc. <br />❑ Show the location of all existing structures. <br />Other Application Requirements (Submit 5 copies of all) <br />❑ Petition for Annexation form listing all owners, including partial owners, and electors. This form includes the <br />Certification of Electors which must be signed by the Lane County Elections/Voter Registration Department and <br />also includes the Verification (Certification) of Property Owners which must be signed by the Lane County <br />Department of Assessment and Taxation. This form is required even if the land is vacant. <br />❑ Notarized Consent to Annexation form. <br />❑ A legal description of the land proposed for annexation, including any public right of way prepared by a <br />registered land surveyor. Oregon Revised Statues (ORS) 308.225 requires submittal of a closing metes and <br />bounds description or subdivision block and lot number description. Please see example of acceptable legal <br />descriptions contained in the application packet. The legal description must exactly correspond with the map <br />included with the application or the Assessor's map. <br />❑ Summary of Urban Service Provision form. <br />❑ A county Assessor's cadastral map. (Available at Lane County Assessment & Taxation) <br />❑ Census Information Sheet. <br />Note: This is not a complete list of requirements. Additional information may be required after further review <br />in order to adequately address the applicable approval criteria. <br />Annexation Last Revised May, 2009 Page 2 of 4 <br />Application Form <br />