1105.11 SAMPLE FORMS.
The sample forms for application, review and approval of preliminary plats, final plat and lot splits are samples of the ones available at the Municipal Building for official use.
(a) Preliminary Plat Forms.
(1)
APPLICATION FOR APPROVAL OF
PRELIMINARY PLAT
PRELIMINARY PLAT
(Ord. 141-83)
1. Name of Applicant ____________________
Address _______________________
Phone _________________________
2. Name of Owner of Record ______________
Address ________________________
3. Name of Surveyor or Engineer ___________
Address ________________________
Phone __________________________
4. Name of Subdivision ____________________
5. Locational Description: Section __________ Town __________
Range ______________
(In addition, please attach copy of legal description.)
6. Proposed Use __________________________
7. Present Zoning District ___________________
8. Number of Lots ________ Acreage of Parcel _____
9. Do you propose deed restrictions? Yes ______ No _______
(If yes, please attach a copy.)
10. In which elementary school district is this parcel located?
(i.e., South, Central, West) _________________
11. Attach 12 copies of Preliminary Plat.
The undersigned agrees that the submittal date for this plat shall be as defined in Section 1105.03(b)(5), the date on which the Planning Commission first considers the plat at a regular meeting.
_______________________________________
Date Signature of Applicant or Authorized Agent
OFFICIAL USE ONLY
Date received ____________________
Date of meeting of Planning Commission ____________________ (Official submission date)
Filing Fee: Amount __________
Paid by __________
Check No. __________
Date __________
Action by Planning Commission _____________
Date _______________
If plat was rejected, reason(s) for rejection: _______________ ________________________________________________ ________________________________________________
Date __________ _______________
Chairman
(2)
PRELIMINARY PLAT CHECKLIST
Subdivision ____________________
The following items (do, do not) conform with the requirements of Section 1105.04(b) of the Subdivision Regulations.
Does Does Not Item
1. __________ __________ Vicinity Map
2. __________ __________ Subdivision Name
3. __________ __________ Tract Designation
4. __________ __________ Names and address of owner, subdivider, surveyor.
5. __________ __________ Names of adjoining subdivisions and owners of adjacent parcels of unplatted land.
6. __________ __________ Boundary lines and approximate acreage.
7. __________ __________ Location and width of existing streets within or adjacent to the tract; features such as rights-of-way, public open spaces, buildings, large trees, water-courses, section and corporation lines, floodway boundaries.
8. __________ __________ Existing utility lines, culverts, etc. with pipe sizes; proposed sanitary sewer and water lines with proposed connections to existing system; provisions for drainage of storm water.
9. __________ __________ Existing contours - 2 foot intervals
10. __________ __________ Layout of proposed streets and lots with dimensions.
11. __________ __________ Existing zoning, including zoning boundary lines, if any; proposed use and setback lines.
12. __________ __________ Proposed dedication of public land or reservations for common use of property owners.
13. __________ __________ North point, scale and date.
14. __________ __________ Copy of proposed deed restrictions, if any.
Date ___________________________ Title _____________________________
______________________Signature
(b) Final Plat Forms.
(1)
SUBDIVISION REGULATIONS
(Ord. 141-83)
City of Fairfield, Ohio
Application for Final Plat Approval
1. Name of Subdivision ____________________
2. Name of Applicant ____________________
Address _______________ Phone _______________
3. Name of Local Agent, if any ____________________
Address ____________________
4. Owner of Record ____________________
Address ____________________
5. Engineer ____________________
Address _______________ Phone _______________
6. Surveyor ____________________
Address _______________ Phone _______________
7. Have the necessary construction drawings and construction cost estimates been furnished the City Engineer? _______________
8. Do you propose deed restrictions? __________ Yes __________ NO (If yes, please attach a final copy.)
9. Total Acreage ____________________
10. Zoning Classification of Property ____________________________
(i.e., A-1, R-O, R-1, etc.)
11. Number of Lots ____________________
Date of Preliminary Plat Approval _______________
12. Have any changes been made since this Plat was last before the Planning Commission? ____________________
Attach an affidavit of ownership indicating the dates the respective holdings of land were acquired, together with the book and page of each conveyance into the present owner as recorded in records of the Butler County Recorder. This affidavit shall indicate the legal ownership of the property, and the date the contract of sale was executed.
The undersigned agrees that the submittal date for this plat shall be defined as in Section 1105.03(b)(5), the date on which the Planning Commission first considers the plat at a regular meeting.
_______________ __________________________________
Date Signature of Applicant or Authorized Agent
FOR OFFICIAL USE ONLY
Filing Fee _______________
Paid by _______________
Check No. _______________
Date _______________
Date Received _______________
Date of Meeting of Planning Commission ____________________
(Official Submission Date)
Action by Planning Commission ___________________________
Date of Action __________________________________
If Plat was rejected, reason(s) for rejection ___________________
____________________________________________________
____________________________________________________
_______________ ____________________
Date Chairman
(2)
SUBDIVISION REGULATIONS
(Ord. 141-83.)
Final Plat Checklist
Date _______________
Subdivision ____________________
The following items (do, do not) conform with the requirements of Section 1105.05(b)
of the Subdivision Regulations.
Does Does Not Item
1. __________ __________ Submitted within 12 months of preliminary approval.
2. __________ __________ Conforms to Preliminary Plat and incorporates suggested changes.
3. __________ __________ Vicinity sketch.
4. __________ __________ Boundaries of subdivision.
5. __________ __________ Location and width of existing public streets.
6. __________ __________ Bearings and distances of permanent monuments.
7. __________ __________ Location and material of all permanent monuments.
8. __________ __________ Layout, including street and alley lines, length of arc radii, points of curvature and tangent bearings, public and private easements, lot lines.
9. __________ __________ Lots in numerical order.
10. __________ __________ Municipal, township, county or section lines located within or adjacent to tract.
11. __________ __________ Dimensions and description of any property dedicated for public use or reserved for common use of property owners.
12. __________ __________ Easements are provided for watercourses, channels, streams or creeks traversing subdivision and retention/detention facilities and include any flood hazard area. Notes on plat are in conformance with Chapter 1105.
13. __________ __________ Building setback lines.
14. __________ __________ Private restrictions, if any.
15. __________ __________ Name of subdivision.
16. __________ __________ Name and location of adjoining subdivisions and owners of unsubdivided adjoining property.
17. __________ __________ Names and addresses of owners, surveyors, engineer and subdivider.
18. __________ __________ North point, scale and date.
19. __________ __________ Certification by surveyor, and standard statements regarding easements, lots, streets, etc., and signature blocks.
20. __________ __________ Statement concerning sewer service charge.
21. __________ __________ Certificate of title.
22. __________ __________ Plat of land of dedicators.
23. __________ __________ Signature of any mortgagor holding mortgage on property.
Date _____________________ ___________________________________
Title
___________________________________
Signature
(c) Lot Split Forms.
APPLICATION FOR MINOR SUBDIVISION
(Lot Split)
Fairfield Planning Commission
Fairfield, Ohio
Date _______________
The undersigned applies for Minor Subdivision approval under Section 1105.06 of these Regulations, and certifies all material submitted with this application is true and correct.
In accordance with the provisions of Section 1105.06(a) of Subdivision Regulations of the City of Fairfield, Ohio, this application shall be approved or disapproved within seven working days.
IDENTIFICATION OF PROPERTY
Old Lot No.(s) __________ New Lot No.(s) __________
Address of Property (if applicable) _______________
Located ____________________ (Identify location of property as being off _____ street, or fronting _____ street, etc.)
Signature _____________________
Address ____________________
Phone ____________________
Minor Subdivision approval may be granted only under the following conditions:
1. The proposed subdivision is along an existing public road and involves no openings, widening or extension of any street.
2. No more than five lots are involved after the original parcel has been completely subdivided.
3. The subdivision is not contrary to applicable platting, subdividing or zoning regulations.
4. The property has been surveyed and a sketch and legal description is submitted.
Note: Three copies of the sketch or plat of survey should be provided with the application.
FOR OFFICIAL USE
Action _________________________________________________
Comments ______________________________________________
_______________________________________________________
Filing Fee Amount __________ Approved by City Planning Commission Fairfield, Ohio
Paid by _________________ No Plat required
Check No. ______________ _________________________
Signature
Date___________________
_________________________
Title
(Ord. 141-83. Passed 9-26-83.)