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Annexation Application/Petition Revised 9/24/2015 Page 1 Annexation Application / Petition Owner: Phone No.: Email: Owner’s Mailing Address: (If several property owners are requesting the annexation, names, addresses, contact information, and legal descriptions of each owner’s property within the proposed annexation must be given, as well as proof of ownership. Signed and dated petition addendums must be received from a majority of the property owners owning a majority of the land seeking annexation, excluding public streets, alleys, and tax exempt property. Attach additional Annexation Application/Petition Addendums as necessary.) Applicant/Agent: Telephone: Applicant/Agent’s Company (if applicable): Applicant/Agent’s Address: Applicant/Agent’s Email Address: Legal Description of Total Site Requesting Annexation: Total Site Area (sq. ft. and/or acres): Address (if available) or Location Description: Current Land Use: Requested Zoning: (Zone changes must be processed separately from the annexation.) Surrounding Land Uses and Zoning: North: Land Use: Zoning: City or County: South: Land Use: Zoning: City or County: East: Land Use: Zoning: City or County: West: Land Use: Zoning: City or County: ---PAGE BREAK--- Annexation Application/Petition Revised 9/24/2015 Page 2 It is proposed that the property will be annexed for the following purposes: (e.g. single family residences, multiple family residences, mobile home park, commercial, industrial, rights-of-way, etc.) Give area and number of each: Percentage of the perimeter of the area proposed for annexation contiguous to the City limits: Number of residential units existing on the property: Anticipated number of employees: Anticipated number of employee/company vehicles: I hereby certify that I am the owner , applicant, or agent named herein and that I have familiarized myself with the rules and regulations with respect to the filing of this application and that the foregoing statements and answers contained on the application and attached map are true and accurate to the best of my knowledge. If separate, the original signatures of the owner(s) and the agent are required for submission of this application. Signature of Owner(s): Date: Date: Date: Date: Signature of Agent: Date: ALL APPLICATION/PETITIONS MUST BE ACCOMPANIED BY PROOF OF OWNERSHIP; ONE PAPER COPY AND A .PDF ELECTRONIC COPY OF THE BOUNDARY PLAT OF THE AREA SEEKING ANNEXATION; AND A FEE OF $250. Community Development Department Use Only Date Application Received: Date Plat Received: Date Application Fee Received: Receipt No.: SIGN SIGN ---PAGE BREAK--- Annexation Application/Petition Revised 9/24/2015 Page 3 Annexation Application / Petition Addendum Owner: Phone No.: Email: Owner’s Mailing Address: Applicant/Agent: Telephone: Applicant/Agent’s Company (if applicable): Applicant/Agent’s Address: Applicant/Agent’s Email Address: Legal Description of Total Site Requesting Annexation: Total Site Area (sq. ft. and/or acres): Address (if available) or Location Description: Current Land Use: Requested Zoning: (Zone changes must be processed separately from the annexation.) I hereby certify that I am the owner , applicant, or agent named herein and that I have familiarized myself with the rules and regulations with respect to the filing of this application and that the foregoing statements and answers contained on the application and attached map are true and accurate to the best of my knowledge. If separate, the original signatures of the owner(s) and the agent are required for submission of this application. Signature of Owner(s): Date: Date: Date: Date: Signature of Agent: Date: SIGN SIGN