§ 4 PRELIMINARY PLAT REQUIREMENTS AND CHECK LIST
                                          YES   NO
Fifteen (15) copies submitted 21 days prior to hearing                     ____   ____
Notification of hearing to subdivided and adjoining property owners               ____   ____
Copies sent to Resident/County Engineer (or appropriate official) and County          
Health Department for recommendation                           ____   ____
Plat contents, per § 153.18(A), as follows:
A. Date                                       ____   ____
Label “Preliminary Plat;”                              ____   ____
Graphic scale (not less than 1" = 200');                        ____   ____
North arrow;                                    ____   ____
Vicinity sketch map (1"= 2,000 feet).                           ____   ____
B. Name and location of subdivision.                           ____   ____
   Name and address of property owner, subdivider (if other than owner)         ____   ____
   and developer
   Name, address and seal of the registered licensed professional land surveyor
   responsible for preparation of the plan and supplementary plans             ____   ____
   Names of adjacent property owners of record and abutting subdivisions and streets   ____   ____
C. Acreage of land to be subdivided to nearest 1/100th acre                  ____   ____
D. Contours at an interval of not greater than five (5) feet or at a lesser interval
if deemed necessary by the Planning Commission                     ____   ____
E. Boundaries of the tract, showing all bearings and distances               ____   ____
F. Existing and proposed easements and their locations, widths and distances         ____   ____
G. Existing and proposed street layout, depicting streets on and adjacent to the tract      ____   ____
Street names (selected so as not to duplicate any other within the county)         ____   ____
   Street widths, approximate grades, profiles (1" = 20'), and other dimensions as
   may be required                                 ____   ____
H. Utilities on and adjacent to the tract showing proposed connections to existing
utility systems                                    ____   ____
   Existing culverts and watercourses                        ____   ____
   Rear easements for utility poles shall be required wherever possible         ____   ____
I. Proposed lot lines and lot numbers                           ____   ____
J. Sites and their acreages, if any, to be reserved or dedicated for parks, playgrounds,      ____   ____
schools or other public uses
   Sites, if any, for semi-public, commercial or multi-family use               ____   ____
K. Minimum building setback lines                           ____   ____
L. Copies of proposed deed restrictions (if applicable)                     ____   ____
M. Clearly indicate or discuss proposed erosion control methods during            ____   ____
construction
O. Certificates 1, 2, 4, 6, 7 and 8 as indicated in the Appendix               ____   ____