Name of subdivision:                                                                                                  
Date of admission:                                                                                                      
Due date of recommendation (30 days):                                                                        
             1. Plat has been submitted within six months after the approval of the engineering plans.
             2. Plat has been submitted within one year after the approval of the primary plat (unless an extension of time has been requested of and granted by the Plan Commission).
             3. One original drawing of the final plat has been submitted.
             4. One transparency print of the final plat has been submitted.
             5. Four copies of the final plat have been submitted.
             6. Plat is drawn with waterproof India ink on heavy linen tracing cloth or equal.
             7. North direction is shown.
             8. Scale is shown (minimum one inch equals 100 feet).
             9. Section corners and section lines are accurately tied into subdivision by distance and angle.
             10. Official survey monuments are shown and dimensioned.
             11. All necessary easements are shown and dimensioned.
             12. Building setback lines are shown and dimensioned in accordance with the zoning ordinance.
             13. Lot areas are in accordance with the applicable zoning regulations.
             14. Street names are shown.
             15. Areas to be dedicated or reserved for public use are shown and described and the purpose is designated.
             16. Protective covenants are lettered on the plat or are appropriately referenced.
             17. Required certificates are shown and signed.
                A. Surveyor's certificates (including legal description).
                B. Owner's certificate.
                C. Notary certificates.
             18. Other required certificates are shown.
                A. Plan Commission certificate.
                B. City Engineer.
                C. Utility Director.
                D. Common Council certificate.
                E. Indiana State Highway Commission, if fronting or crossing state highway right-of-way.
             19. The following items have been submitted with the final plat:
                A. Detailed specifications for all required land improvements not previously submitted and approved with the engineering plans.
                B. A copy of the IDEM permit for the sanitary sewer installation.
                C. A copy of the IDEM approval of the water main installation.
                D. An affidavit by the subdivider acknowledging responsibility for the proper installation of all required land improvements.
                E. A certified estimate of cost of all required land improvements prepared by a engineer or land surveyor registered in the State of Indiana.
                F. A description of the bond or guarantee collateral intended to be submitted after contingent approval or granted by the Common Council.
Completed by:                                                                                                           (Name)
Reviewed by:                                                                                           , City Engineer
Reviewed by:                                                                                           , Utility Director
Considered by Plan Commission on                                                                         (Date)
Considered by Common Council on                                                                         (Date)
(Ord, - -, passed - -)