APPENDIX B: FORMS
Form 1
PRELIMINARY PLAN CHECKLIST
Date____________________________   Application Number_____ ____________________
Subdivision____________________________________________________________________
The following item(s) (does, does not) conform with the requirements of the Winchester/Clark County Subdivision Regulations. All preliminary development plans shall conform with the requirements of the Winchester/Clark County Subdivision Regulations. All preliminary plans shall conform with the requirements of the Winchester/Clark County Subdivision Regulations.
   Does   Does Not   Item
1.   _____   _____      Name of subdivision (no duplication permitted)
2.   _____   _____      Scale of 1" = 50' or less
3.   _____   ____      Date of preparation, north arrow, written scale
4.   _____   _____      Names of adjacent subdivisions and owners
5.   _____   _____      Zoning classification of all major parcels and proposed changes
6.   _____   _____      Topography at two-foot intervals
7.   _____   _____      Location, width, and names of existing streets, right-of-ways, easements
8.   _____   _____      Location of existing utilities including sewers, water lines, and communication lines or poles
9.   _____   _____      Layout, names and widths of proposed streets or easements and proper dedications
10.   _____   _____      Layout and approximate dimensions of all lots
11.   _____   _____      Building setback lines
12.   _____   _____      Survey monuments of adjacent properties
13.   _____   _____      Proposed use of lots
14.   _____   _____      Sewage treatment and percolation test results
15.   _____   _____      Adequate preliminary improvement plans
16.   _____   _____      Required certifications
17.   _____   _____      Stormwater study and drainage calculations
18.   _____   _____      Design based on CBR test results for every 500 lf oft.
19.   _____   _____      Type A or B drainage box inlets provided
Date____ ________________________   
Title of Position___________________
________________________________
Signature
 
Form 2
FINAL PLAT CHECKLIST
Date____________________________   Application Number____________________________
Subdivision____________________________________________________________________
The following item(s) (does, does not) conform with the requirements of the Winchester/Clark County Subdivision Regulations. All final development plans shall conform with the requirements of the Winchester/Clark County Subdivision Regulations. All final plats shall conform with the requirements of the Winchester/Clark County Subdivision Regulations.
   Does   Does Not   Item
1.   _____   _____      Submitted within 12 months of preliminary approval
2.   _____   _____      Conforms to preliminary plan and incorporates suggested changes
3.   _____   _____      Name of subdivision
4.   _____   _____      Written scale, date and north arrow
5.   _____   _____      Property identification
6.   _____   _____      Name and address of owner, surveyor, and engineer
7.   _____   _____      Accurate survey data-seconds, lineal dimensions to hundredths of feet; radii internal angles, points of curvature; tangent bearing; lengths of arcs; lengths of cords
8.   _____   _____      Closure
9.   _____   _____      Bearings and distances to permanent monuments
10.   _____   _____      Lot numbers, dimensions and addresses
11.   _____   _____      Location and description of monuments
12.   _____   _____      Building setback lines
13.   _____   _____      Final deed restriction
14.   _____   _____      Required final certifications
15.   _____   _____      Special notes
16.   _____   _____      Acreage on plat
17.   _____   _____      Thirty-foot dedicated right-of-way
18.   _____   _____      All proposed and existing roadway entrances indicated and certification that proposed entrance(s) have been approved by the agency having jurisdiction
19.   _____   _____      Existing improvements, structures and utilities
20.   _____   _____      Health Department approval
21.   _____   _____      Flood plain elevation or appropriate notation
22.   _____   _____      Proof roll test
23.   _____   _____      Cluster worksheet (for ag. Divisions> 60 acres or eight tracts)
Date____________________________
Title of Position___________________
________________________________
Signature
 
Form 3
TECHNICAL DESIGN AND IMPROVEMENT CHECKLIST
The following item(s) (does, does not) conform with or does not apply (N.A.) to the requirements of the Winchester/Clark County Subdivision Regulations. Those items not conforming are explained on the final page:
Does   Does Not   N.A. Item
   General
1.   _____   _____   _____   Conformance with major street plan
2.   _____   _____   _____   Conformance with zoning regulations
3.    _____   _____   _____   No flood hazards
4.    _____   _____   _____   Acceptable natural drainage and erosion control
5.    _____   _____   _____   Steep slopes not limiting factor
6.    _____   _____   _____   Large trees and other significant natural features
7.    _____   _____   _____   Areas of historical or cultural significance
   Streets
8.    _____   _____   _____   Right-of-way widths
9.    _____   _____   _____   Pavement widths
10.   _____   _____   _____   Radius of curvature
11.   _____   _____   _____   Horizontal visibility
12.   _____   _____   _____   Vertical alignment and visibility
13.   _____   _____   _____   Grades
14.   _____   _____   _____   Cul-de-sacs
15.   _____   _____   _____   Turn-around radius - ROW - and pavement
16.   _____   _____   _____   Dead-end streets
17.   _____   _____   _____   Dedication and addition of half streets
18.   _____   _____   _____   Marginal access streets, points of access, and planting strips
19.   _____   _____   _____   Alleys
20.   _____   _____   _____   Alignment of intersections
21.   _____   _____   _____   Spacing of intersection relative to different road classifications
22.   _____   _____   _____   Avoidance of multiple intersections
23.   _____   _____   _____   Avoidance of 4-way intersections
24.   _____   _____   _____   Pavement and ROW of intersections
25.   _____   _____   _____   Streets for commercial subdivisions
26.   _____   _____   _____   Repair of pavement
27.   _____   _____   _____   Streets for industrial subdivisions
28.   _____   _____   _____   Crosswalks
29.   _____   _____   _____   Street monuments
30.   _____   _____   _____   Subgrade
31.   _____   _____   _____   Base course
32.   _____   _____   _____   Surface course
33.   _____   _____   _____   Curbs and gutters
34.   _____   _____   _____   Bridges
35.   _____   _____   _____   Sidewalks
36.   _____   _____   _____   Street names and numbers, signs
   Lots
37.   _____   _____   _____   Size
38.   _____   _____   _____   Setback lines
39.   _____   _____   _____   Corner lot size
40.   _____   _____   _____   Avoidance of double frontage lots
41.   _____   _____   _____   Driveway culverts and grade
42.   _____   _____   _____   Monuments
43.   _____   _____   _____   Grading plan
   Others
44.   _____   _____   _____   Parks and open spaces
45.   _____   _____   _____   Type of water supply
46.   _____   _____   _____   Test wells
47.   _____   _____   _____   Type of sewage treatment
48.   _____   _____   _____   Percolation test results
49.   _____   _____   _____   Storm drainage system type
50.   _____   _____   _____   Manholes
51.   _____   _____   _____   Catch basins
52.   _____   _____   _____   Headwalls
53.   _____   _____   _____   Sufficient easements for utilities or open drainage
54.   _____   _____   _____   Other utilities
55.   _____   _____   _____   Underground utilities
Date____________________________
Title____________________________
________________________________
Signature
 
Form 4
APPLICATION FOR PLAT APPROVAL
   Winchester/Clark County
   Planning Commission
   Winchester, Kentucky
Date                                            Application No._                 
( )   Preliminary Plat
( )   Final Record Plat
( )    Minor Subdivision Plat
1.   Name of Applicant                               
   Address                                      
   Phone_                                        
2.   Name of Surveyor or Engineer                      
   Address_                                     
   Phone                                         
3.   Name of Subdivision                            
4.   Present Zoning District                            
5.   Number of Lots                                   
6.   Total Area of Parcel                               
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   For Official Use
Date Received                                             
Date of Planning Commission Action                                            
Plat Fee $                 
( )   Approved
( )   Disapproved Additional Comments:
                                                                                                            
                                                                                                                     
                                                                                                                   
                                                                                                                  
   For Official Use
   COUNTY BOARD OF HEALTH
Date Received       
Action             
Comments
                                                                                                            
                                                                                                                     
                                                                                                                   
                                                                                                                  
Signature                            
***********************************************************************************
   PLANNING COMMISSION ENGINEER
Date Received             
Action                   
Comments
                                                                                                            
                                                                                                                     
                                                                                                                   
                                                                                                                  
Signature                            
***********************************************************************************
   PLANNING COMMISSION
Date Received             
Action                   
Fee             Paid $         
Comments
                                                                                                            
                                                                                                                     
                                                                                                                   
                                                                                                                  
Signature                            
Note: This form must be submitted to the County Auditor for transfer and the County Recorder for recording.
(Ord. passed 3- -1995; Ord. passed 10- -2005; Ord. 2018-03, passed 2-14-2018; Ord. passed 1- -2020)