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APPLICATION FOR ANNEXATION Planning Division Annexation No.: 38250 Sierra Highway Palmdale, CA 93550 Date: (661) 267-5200 [EMAIL REDACTED] Received by: Print Name INSTRUCTIONS TO APPLICANT The following application form is provided for all applicants requesting to be annexed by the City of Palmdale. CONTACT THE PLANNING DIVISION REGARDING REQUIRED ITEMS AND FEES. ALL ITEMS ARE SUBJECT TO CHANGE. The applicant must complete the attached from as prescribed and submit the following information before the application can be accepted by the Planning Division. ANNEXATION SUBMITTAL CHECKLIST The completed Application A copy of the Development Advisory Board (DAB) letter (if applicable) Original Owner Authorization Letter Seven copies of the legal description DOUBLE SPACED (see attached instructions) Two original annexation boundary maps per the attached instructions One copy of the map (11” x 17”); two copies of the map (17” x 22”); and one copy (8½” x 11”). If a reduced map is filed, the original map must have a graphic scale affixed to it before the reduction is made Three copies of a list of assessor parcel numbers affected by the annexation Two copies of a radius map (see instructions) Tabular list of the addresses of all structures within the annexation area Two sets of mailing labels for properties within the annexation area (see instructions) ---PAGE BREAK--- One set of mailing labels for properties within the annexation area plus within 300’ radius Photocopy of the above sets of labels Original Property Owners Certification Three copies of the vicinity map (see instructions) One electronic copy and two hard copies of the Initial Study FEE CALCULATIONS* Base Fee $ 4,000.00 @ $5 / acre # of acres LAFCO Fees: *LAFCO Postage Fee: State Board of Equalization Fees: Assessor’s Processing Fee of Parcels ($20/parcel for first 50 parcels; $10/parcel thereafter up to $1,500 maximum) Environmental Review Fee: 950.00 @ $1.65 / label x 2: # of labels within annexation Public Hearing Notice: Computer Tracking Fee: GIS Fee 5% of + TOTAL FEE RECEIVED: *LAFCO postage fees are calculated using the current postage fees for a 1 oz. letter based on 2 sets of mailing labels (one with and one without the 300’ radius). If you have any questions regarding this application packet, required materials, or fees, please call the Planning Division at 661/267-5200. ---PAGE BREAK--- APPLICATION FOR ANNEXATION Pre-Application Number: Annexation Number: Request to annex acres/square miles to the City of Palmdale. PROJECT LOCATION: North/South Boundaries Approximately Feet N or S of (Circle) (Street Name or Alignment) Approximately Feet N or S of (Circle) (Street Name or Alignment) East/West Boundaries Approximately Feet E or W of (Circle) (Street Name or Alignment) Approximately Feet E or W of (Circle) (Street Name or Alignment) Thomas Guide Page: Coordinates: Assessor’s Parcel Number(s): List all related applications being filed with this project: APPLICANT: Name: Address: City: State: Zip: Telephone No.: ( ) Fax No.: ( ) Email Address: OWNER: Name: Address: City: State: Zip: Telephone No.: ( ) Fax No.: ( ) Email Address: ENGINEER/REPRESENTATIVE: Name: Address: City and State: Telephone No.: ( ) Fax No.: ( ) Email Address: Please include in mailing list all other persons to be notified regarding this application. ---PAGE BREAK--- The City of Palmdale requires accurate information on the following subjects in order to process an annexation. Please answer the following questions, and when necessary, give the source of the information. Describe any physical features of the subject area not included on the Land Use Map. What major highways and streets serve the area? What is the estimated population of the area? How many registered voters reside in the area? Source and date of information: Number and type of dwelling units: What is the City’s General Plan Land Use and Pre-Zone designation for the area? If this proposal will result in development of the property, describe the type of development proposed (type of business or industry, single- or multi-family residential, etc.; number of units or facilities): Attach a document describing the services to be extended to the subject area, the range and level of those services, when the services can be extended to the area, and how the services will be financed. Include any improvement or upgrading of structures, roads, sewer or water facilities, or other conditions which would be imposed or required by the local agency within the subject area if this proposal is completed. Specifically address the following services*: 1. Sewer 6. Gas 12. Solid Waste Disposal 2. Water 7. Parks & Recreation 13. Flood Control 3. Police 8. Library 14. Special Assessment Districts 4. Fire 9. Electricity 15. Street Lighting 5. Phone 10. Animal Control 6. Schools 11. Road Maintenance *The City may require the preparation of a Master Infrastructure Plan and Fiscal Impact Report to determine the appropriateness of the expansion of the City. List the division, acquisition, improvement, disposition, sale or transfer of any property, real or personal, belonging to a city or district that is involved in this proposal: ---PAGE BREAK--- To what extent will residents or landowners within the subject area be liable or remain liable for any existing indebtedness of the city or district to or from which annexation or detachment is proposed? What services and/or costs to residents or landowners in the area would be reduced or eliminated as a result of this proposal? List any terms or conditions requested as part of this proposal: List names and addresses of any persons, organization, or agencies known to you who may be opposed to this proposal: ANY OTHER COMMENT YOU MAY WISH TO MAKE: ---PAGE BREAK--- SUPPLEMENTAL INSTRUCTIONS FOR ANNEXATION SUBMITTAL CHECKLIST TITLE BLOCKS: Title Blocks for both the annexation boundary map and legal description shall contain the following: • Affected Agency(s) • Agency or firm responsible for the preparation of the map and legal description, along with a certified seal of either a licensed land surveyor or registered civil engineer shown on the map and the legal description • General location • Date of preparation or subsequent revision • Designation of the proposal as determined by LAFCO LEGAL DESCRIPTION: 1. Legal description shall be prepared in accordance with State Board of Equalization requirements. BOE standards are available through LAFCO’s website at www.lalafco.org under “forms”. The legal description shall be double-spaced and must bear the designation of the proposal “Annexation No. 1” to the City of Palmdale). NOTE: CALL LAFCO OFFICE FOR PROPOSAL DESIGNATION AT (818) 254-2454. 2. Every written geographic description must be self-sufficient within itself and without the necessity of reference to any extraneous document. The written geographic description shall be a document separate from any maps. The polygon traverse of the written description must be within acceptable limits for error of closure. 3. The use of secondary references in the written description is cause for rejection. The cartographic staff must be able to plot the boundaries from the written descriptions. 4. The point of beginning of the geographic description shall be clearly shown on the map and referenced to a known geographic position. It is recommended that the known point be described by the California State Plane Coordinate System, 1983 datum. It is preferred that this point be either the point of beginning or the point of departure from and the point of return to an existing district boundary. Effective January 1, 2000, every description shall contain a minimum of one GPS point that is referenced to the California State Plane Coordinate System. 5. When writing a metes and bounds description of a contiguous annexation, all details of the contiguous portion(s) of the boundary may be omitted. Points of departure from the existing boundary must be clearly established. 6. A specific parcel description in sectionalized land the SW ¼ of Section 22, T1N, R1W) is permissible without a metes and bounds description of the perimeter boundary. 7. A parcel description making referenced only to a subdivision or a lot within a subdivision is not acceptable unless accompanied by a copy of the recorded subdivision map. ---PAGE BREAK--- 8. State the acreage for each separate single area and the combined total acreage of subject territory. Acreage shall be rounded off to the nearest whole acre. ANNEXATION BOUNDARY MAP: Maps shall be prepared in accordance with State Board of Equalization standards, which are available on LAFCO’s website under “forms”. Effective July 1, 1995, maps filed with the State Board of Equalization may be submitted electronic / digital form. Please contact SBE Tax Area Service at 450 N Street, MIC: 59, P. O. Box 942879, Sacramento, CA 94279-0059 or by fax at 916/327-4251 for a copy of the requirements. 1. All maps must be professionally drawn or copied. Rough sketches or pictorial drawings will be rejected. 2. The map must clearly indicate all existing streets, roads, and highways within and adjacent to the subject territory, together with the current names of these thoroughfares. Other pertinent physical features should be included. 3. The map must bear a scale and north point. Every map shall be of a sufficient size to plot the boundary without difficulty. Every map shall be of a scale common to the industry. All lettering and numbers on the map must be legible. 4. The point of beginning of the legal description, the designation of the proposal, and the name of the affected agency must be shown on the map. 5. All dimensions needed to plot the boundaries must be given on the map of the subject territory. The relationship of the subject territory to street rights-of-way and street centerlines must be clearly indicated. 6. The boundaries of the subject territory must be distinctively shown on the map without obliterating any essential geographic or political features. Boundary lines that are delineated by a line that exceeds 1.5 millimeter in width shall be rejected. The use of graphic tape or broad tip marking pens to delineate the boundary is not acceptable. 7. Maps of the subject territory shall be drawn to these standard minimum scales: (For a multiple-area filing, the size of each single area should govern the map scale.) ACREAGE WITHIN PROJECT AREA MINIMUM SCALES MAP SCALES 1-40 acres 1” = 100’ 41-200 acres 1” = 200’ 201-1,000 acres 1” = 400’ or 1” = 800’ Over 1,000 acres 1” = 800’ or 1” = 1,200’ 8. If any segment of the boundary is shorter than 1/40 of the map scale 10 feet on a 400’ scale map) that segment should be shown enlarged in a marginal sketch. 9. When the boundary of the subject territory is of a complex nature, an index table listing the various courses with the bearings and distances shall be shown on the map. ---PAGE BREAK--- 10. When it is necessary to use more than one map sheet to show the boundaries of the subject territory, the sheet size shall be uniform. A small key map giving the relationship of the several sheets shall be furnished. Match lines between adjoining sheets shall be used. While the geography on adjoining sheets may overlap, the project boundaries must stop at the match lines. 11. If the subject territory has interior islands of exclusion or the boundary has a peninsula of exclusion (or inclusion) that areas(s) shall be shown enlarged in a marginal sketch. This sketch shall be of a sufficient size and scale to plot the boundary without difficulty. The parcels in the sketch that touch the boundary shall be clearly labeled with the assessor parcel numbers. 12. All parcels within the subject territory that touch the new boundary must be clearly labeled with the assessors parcel number. It is recommended that assessor parcel maps with the subject territory delineated in red accompany the filing as supporting documentation. 13. The use of assessor parcel maps and copies of Board of Equalization maps shall be in addition to and shall not be a substitute for the required project map. RADIUS MAP (maximum size of 17” x 22”): 1. Obtain the County Assessor’s parcel maps covering the annexation area and all properties within 300 feet (available at the County Assessor’s office). 2. Outline the annexation area on the Assessor’s map in red and draw a 300’ radius around the annexation boundary. 3. If the number of parcels is not excessive, indicate the Assessor’s Parcel Number (APN) of every parcel within the annexation area on the map. List the APN on the mailing label (see below). If impractical to list APNs on the map, cross-reference to the tabular mailing list. 4. Show existing land uses within the annexation area and for properties within the 300’ radius. MAILING LABELS: Refer to the latest available County Assessment roll and provide on set of self-sticking address labels (2-5/8” x indicating the cross-referenced number from the radius map, Assessor’s Parcel Number (APN), name and address for each parcel for both the owner and occupant (address to “Occupant”) whose property is wholly or partially included within the annexation area, including apartment complexes and mobile home parks. Include mailing labels for the applicant and the applicant’s engineer or representative. If the applicant has not provided all property mailing labels for legal public notice, the City Council and/or LAFCO may continue the public hearing in order to provide such notice. VICINITY MAP: On 8½” x 11” exhibit, show area to be annexed, adjoining subdivisions, creeks, railroads, major cross streets and other data sufficient to locate the proposed annexation in relationship to the surrounding community. ---PAGE BREAK--- CITY OF PALMDALE PLANNING DIVISION PROPERTY OWNERS CERTIFICATION ANNEXATION NUMBER: I certify under the penalty of perjury that on the day of the attached property owners list contains the names and addresses of persons to whom property is assessed as they appear on the latest available equalized assessment roll of the County of Los Angeles within the subject property and for the parcels within 300 feet of the boundary of the subject property. PLEASE PRINT REQUESTED INFORMATION. Name: Title: Company: Address: City: State: Zip: Phone: ( ) Signature: Date: ---PAGE BREAK--- CITY OF PALMDALE PLANNING DIVISION OWNER AUTHORIZATION LETTER ANNEXATION NUMBER: ASSESSOR’S PARCEL NUMBER(S): If the applicant is not the owner of record, then a letter authorizing the applicant to represent the owner(s) must be submitted. Note: All owners must sign as their names appear on the deed to the land. This letter shall serve to notify and verify that I/we am/are the legal owners of the property described and attached hereto and do hereby authorize the applicant to file and represent my/our interest in the above referenced applications(s). I/we have read this Letter of Authorization and know the contents thereof; and so hereby certify (or declare) under penalty of perjury under the laws of the State of California that the information contained in the above referenced application(s) is true and correct. OWNER(S) OF RECORD (Include extra sheets if necessary): Printed Name Signature Date Printed Name Signature Date I certify under penalty of perjury that I am the applicant and that the foregoing statements and answers herein contained and the information herein submitted, are in all respects true and correct. APPLICANT / APPLICANT’S REPRESENTATIVE: Printed Name Signature Date Address (including City and State) Telephone Printed Name Signature Date Address (including City and State) Telephone SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 20___ NOTARY PUBLIC NOTE: ATTACH LEGAL DESCRIPTION OF PROPERTY TO THIS DOCUMENT. -10-