(to be filed with minutes)
Name of subdivision:
Location:
Owner:
Telephone:
Address:
Surveyor or engineer:
Telephone
Date submitted:
Fee $
Meeting date:
CHECKLIST
Fees paid.
Approval of County Health Officer received.
Approval of water distribution system received.
Approval of sewerage system received.
Recommendation of suitability of land for development.
Three copies received.
Approved paper size (18 inches to 24 inches or 24 inches to 36 inches).
Map (Scale of 200 feet to one inch or greater).
SHOWN ON PLAT
Name and location of subdivision.
Vicinity map.
Name and address of owners.
Name and seal of engineer or surveyor.
Acreage of land to be subdivided.
Date.
Graphic scale.
North point.
Certificate on plat.
Adjacent property owners.
Contours at five feet or lesser intervals.
Boundary lines.
Proposed and existing easements on and adjacent to tract, and their dimensions.
Present and proposed utilities on and adjacent to tract and proposed connections.
Lot line and lot numbers.
Public sites.
Setback lines.
Protective covenants.
Portion of larger tract and date shown.
Approval given:
Approval refused:
Grounds for refusal, if not shown above or conditions or modifications required:
Variances granted (if any):
Subject to approval of Board of Adjustments:
Approval received:
Date of action of Planning Commission:
Chairperson, Planning Commission