FORMS AND MATERIALS

 

CHANGE OF ORGANIZATION or REORGANIZATION APPLICATION

 

The following information is required to process a proposal for a change of organization or reorganization. Please file the following documents with the Executive Officer of the Del Norte Local Agency Formation Commission (LAFCO) at the time an application is submitted. Additional information may be requested during staff review of the proposal.

 

1. Completed CHANGE OF ORGANIZATION or REORANIZATION QUESTIONNAIRE.

 

2. (a) A certified resolution of application from an affected city or district; or

    (b) A landowner or registered voter petition making application to LAFCO.

 

3. One copy of a metes-and-bounds legal description of the subject area perimeter.

 

4. One reproducible plat map of the subject area and 10 copies.

 

5. Two copies of a vicinity map of the subject territory.

 

6. Environment documentation to comply with the California Environmental

Quality Act (CEQA) (submit documents from the applicable category only):

(a)  INITIAL STUDY: Submit completed form (available from LAFCO) if no environmental review has been conducted;

 

(b)  CATEGORICAL EXEMPTION: Submit document if an agency has certified that the project qualifies for a categorical exemption from CEQA;

 

(c)   NEGATIVE DECLARATION: Submit document with certifying resolution and Initial Study;

 

(d)  ENVIRONMENTAL IMPACT REPORT (EIR): Submit 15 copies of the Final EIR and certifying resolution, plus one copy of the EIR Appendix.

 

7. If the proposal includes annexation to a city, submit one copy of the city resolution approving the pre-zoning and general plan land-use designations for the subject area.

 

8. LAFCO processing fees (the Del Norte LAFCO FEE SCHEDULE is available at http://www.delnorte.lafco.ca.gov or contact LAFCO staff.)       

                                                                           __________________________

(FOR LAFCO USE ONLY)

1

PROPOSAL QUESTIONNAIRE

 

INTRODUCTION: The questions on this form and its supplements are designed to obtain enough data about the proposed project site to allow the Commission, its staff and others to adequately assess the project. By taking the time to fully respond to the questions on the forms, you can reduce the processing time for your project. You may also include any additional information which you believe is pertinent. Use additional sheets where necessary, or attach any relevant documents.

 

GENERAL INFORMATION

1.       NAME OF PROPOSAL: ________________________________________________________________

__________________________________________________________________________________________________________________________________

 

2.       NAME OF APPLICANT: _______________________________________________________________

MAILING ADDRESS:

___________________________________________________________________________________________________________________________________________________________________________________________________

PHONE:       (_____) __________________________

FAX:           (_____) __________________________

E-MAIL ADDRESS: ____________________________________________________

 

3.       GENERAL LOCATION OF PROPOSAL: _________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________________________________________

 

4.       Does the application possess 100% written consent of each landowner in the subject territory? 

YES ___ NO ___ If YES, provide written authorization for change.

 

5.       Indicate the reasons that the proposed action has been requested. _________________________________________________________________

___________________________________________________________________________________________________________________________________________________________________________________________________

 

6.       Would the proposal create a totally or substantially surrounded island of unincorporated territory?

YES ___ NO ___ If YES, please provide a written justification for the proposed boundary configuration.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

LAND USE AND DEVELOPMENT POTENTIAL

1.       Total land area (defined in acres):

_________________________________________________________________

 

2.       Current dwelling units in area:

_________________________________________________________________

 

3.       Approximate current population in area:

_________________________________________________________________

 

4.       Indicate the General Plan designation(s) of the affected city (if any) and uses permitted by this designation(s):

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Del Norte County General Plan designation(s) and uses permitted by this designation(s):

___________________________________________________________________________________________________________________________________________________________________________________________________

 

5.       Describe any special land use concerns expressed in the above plans.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

6.       Indicate the existing land use.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

What is the proposed land use?

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

7.       For a city annexation, State law requires pre-zoning of the territory proposed for annexation.

Provide a response to the following:

 

a.             Has pre-zoning been completed? YES ___ NO ___

b.             If the response to “a” is NO, is the area in the process of pre-zoning?

               YES ___ NO ___

 

Identify below the pre-zoning classification, title, and densities permitted. If the pre-zoning process is underway, identify the timing for completion of the process.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

8.       On the following list, indicate if any portion of the territory contains the following by placing a checkmark next to the item:

 

□    Agricultural Land Uses                □ Agricultural Preserve Designation

□    Williamson Act Contract              □ Area where Special Permits are Required

□    Any other unusual features of the area or permits required: __________________________________________________________________________________________________________________________________

 

9.       If a Williamson Act Contract(s) exists within the area proposed for annexation to a City, please provide a copy of the original contract, the notice of non-renewal (if appropriate) and any protest to the contract filed with the County by the City. Please provide an outline of the City’s anticipated actions with regard to this contract.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

10.   Will the proposal require public services from any agency or district which is currently operating at or near capacity (including sewer, water, police, fire, or schools)?  YES ___ NO ___ If YES, please explain. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

ENVIRONMENTAL INFORMATION

 

1.       Provide general description of topography. ___________________________________________________________________________________________________________________________________________________________________________________________________

 

2.       Describe any existing improvements on the site as % of total area.

 

Residential   ________________%     Agricultural        ________________%

Commercial ________________%     Vacant              ________________%

Industrial     ________________%     Other                ________________%

 

3.       Describe the surrounding land uses:

NORTH___________________________________________________________

EAST ___________________________________________________________

SOUTH ___________________________________________________________

WEST ___________________________________________________________

 

4.       Describe site alterations that will be produced by improvement projects associated with this proposed action (installation of water facilities, sewer facilities, grading, flow channelization, etc.). ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

5.       Will service extensions accomplished by this proposal induce growth on this site? YES ___ NO ___ Adjacent sites? YES ___ NO ___ Unincorporated ___ Incorporated ___

___________________________________________________________________________________________________________________________________________________________________________________________________

6.       Is this project a part of a larger project or series of projects? YES ___ NO ___ If YES, please explain. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

NOTICES

Please provide the names and addresses of persons who are to be furnished mailed notice of the hearing(s) and receive copies of the agenda and staff report.

 

NAME ________________________________ TELEPHONE NO. _____________

ADDRESS:__________________________________________________________________________________________________________________________

NAME ________________________________ TELEPHONE NO. _____________

ADDRESS:__________________________________________________________________________________________________________________________

NAME ________________________________ TELEPHONE NO. _____________

ADDRESS:__________________________________________________________________________________________________________________________

NAME ________________________________ TELEPHONE NO. _____________

ADDRESS:__________________________________________________________________________________________________________________________

 

CERTIFICATION

I hereby certify that the statements furnished above and in the attached supplements and exhibits present the data and information required for this initial evaluation to the best of my ability, and that the facts, statements, and information presented herein are true and correct to the best of my knowledge and belief.  I understand that if this proposal is approved, the Commission will impose a condition requiring the applicant to indemnify, hold harmless and reimburse the Commission for all legal actions that might be initiated as a result of that approval.

 

DATE _______________________

 

 

            ____________________________________

^{SIGNATURE OF APPLICANT}

 

____________________________________

^{PRINTED NAME OF APPLICANT}

 

____________________________________

^TITLE

 

PLEASE CHECK SUPPLEMENTAL FORMS ATTACHED:

□          ENVIRONMENTAL CHECKLIST AND CERTIFICATION

□          ANNEXATION, DETACHMENT, REORGANIZATION SUPPLEMENT

□          SPHERE OF INFLUENCE CHANGE SUPPLEMENT

□          CITY INCORPORATION SUPPLEMENT

□          FORMATION OF A SPECIAL DISTRICT SUPPLEMENT

□          ACTIVATION OF LATENT POWERS SUPPLEMENT

 

APPLICATION TO BE SUBMITTED, WITH DEPOSIT TO:

LOCAL AGENCY FORMATION COMMISSION

EXECUTIVE OFFICER

508 H STREET, SUITE 2

CRESCENT CITY, CA 95531

 

(707) 465-0836 Telephone

(707) 464-1881  Facsimile

 

SUPPLEMENT

ANNEXATION, DETACHMENT, REORGANIZATION PROPOSALS

 

INTRODUCTION: The questions on this form are designed to obtain data about the specific annexation, detachment and/or reorganization proposal to allow the Commission, staff and others to adequately assess the project. You may also include any additional information which you believe is pertinent. Use additional sheets where necessary, and/or include any relevant documents.

 

1. Please identify the agencies involved in the proposal by proposed action:

ANNEXED TO                                                 DETACHED FROM

__________________________                __________________________

__________________________                __________________________

__________________________                __________________________

 

2. Will the territory proposed for change be subject to any new or additional special taxes, any new assessment districts, or fees?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

3. Will the territory be relieved of any existing special taxes, assessments, district charges or fees required by the agencies to be detached?

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

4. Provide a description of how the proposed change will assist the annexing agency in achieving its fair share of regional housing needs as determined by HCD.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

 

5. PLAN FOR SERVICES:

For each item identified for a change in service provider, a narrative “Plan for Service” (required by Government Code Section 56653) must be submitted. This plan shall, at a minimum, respond to each of the following questions and be signed and certified by an official of the annexing agency or agencies.

 

1. A description of the level and range of each service to be provided to the affected territory.

 

2. An indication of when the service can be feasibly extended to the affected territory.

 

3. An identification of any improvement or upgrading of structures, roads, water or sewer facilities, other infrastructure, or other conditions the affected agency would impose upon the affected territory.

 

4. The estimated cost of extending the service and a description of how the service or required improvements will be financed. A discussion of the sufficiency of revenues for anticipated service extensions and operations is also required.

 

5. An indication of whether the annexing territory is, or will be, proposed for inclusion within an existing or proposed improvement zone/district, redevelopment area, assessment district, or community facilities district.

 

6. If retail water service is to be provided through this change, provide a description of the timely availability of water for projected needs within the area based upon factors identified in Government Code Section 65352.5 (as required by Government Code Section 56668(k)).

 

 

CERTIFICATION

I hereby certify that the statements furnished above and the documents attached to this form present the data and information required to the best of my ability, and that the facts, statements, and information presented herein are true and correct to the best of my knowledge and belief.

 

 

______________________________________________________________

        DATE                                          SIGNATURE OF APPLICANT

 

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