APPLICATION #:_               _ SUBMITTAL DATE:_           _FEES:_________ACCEPTED BY:_________


APPLICANT  / PROPERTY OWNER (PRINT NAME):  

ADDRESS:                                                                          CITY:                                                          STATE:   

ZIP CODE:                                  PHONE(S):  

PROPERTY OWNER (SIGNATURE):

AUTHORIZED REPRESENTATIVE (PRINT NAME):  

ADDRESS:

CITY/STATE:                                                                                                                           ZIP CODE:

PHONE:

AUTHORIZED REPRESENTATIVE (SIGNATURE):

 

GENERAL LOCATION OF PROPERTY:



GROSS ACREAGE:



ASSESSOR PARCEL NUMBER(S):



EXISTING LAND USE:



PROPOSED LAND USE:








I:\P&Z\FORMS\Annexation Applic.doc