DATE ___________________________________________________
APPLICATION NO. ___________________________________________________
1. NAME OF APPLICANT ___________________________________________________
ADDRESS ___________________________________________________
PHONE ___________________________________________________
2. NAME OF SURVEYOR
ADDRESS ___________________________________________________
PHONE ___________________________________________________
3. NAME OF SUBDIVISION______________________________________________ _____
4. DATE PRELIMINARY PLAT APPROVED ___________________________ ______
5. WAS A ZONING MAP AMENDMENT REQUESTED? _____________________________
IF YES, THE PLAT MAY NOT BE APPROVED UNTIL IT CONFORMS WITH THE LOCAL ZONING INCLUDING A CERTIFICATION OF ZONING COMPLIANCE IF A CHANGE WAS REQUESTED.
6. HAVE ALL REQUIRED IMPROVEMENTS BEEN INSTALLED? ________________________
IF NO, INCLUDE DETAILED ESTIMATES OF COST AND A STATEMENT RELATIVE TO THE METHOD OF IMPROVEMENT GUARANTEE. ALL ESTIMATES MUST BE APPROVED BY THE RESPONSIBLE (MUNICIPAL, COUNTY) OFFICIAL.
7. DO YOU PROPOSE DEED RESTRICTIONS? ______________________________
8. WAIVERS REQUESTED FOR PLAT OR DESIGN STANDARDS.
SECTION NUMBER ITEM
A.__________________ _________________
B.__________________ _________________
C.__________________ _________________
D._________________ _________________
E.__________________ _________________
9. LIST OTHER MATERIALS SUBMITTED WITH THE APPLICATION.
ITEM NO. COPIES
A. ____________________ _________________
B. ____________________ _________________
C. ____________________ _________________
D. ____________________ _________________
E. ____________________ _________________
__________________ __ _________________________________
APPLICANT SURVEYOR
***********************************************************************************
FOR OFFICIAL USE — FINAL PLAT
DATE RECEIVED _____________________________________
DATE OF MEETING OF PLANNING COMMISSION ____________________________
ACTION BY PLANNING COMMISSION: _________________________
(1) APPROVED: __ (DATE)_________ to record in County Clerk’s office.
Subject to the following modifications: ___________________________________________________
___________________________________________________________________________________
Variances granted: ___________________________________________________________________
_____________________________________________________________________________________
,OR
(2) DISAPPROVED: ____ (DATE)____________________
For the following reasons: ______________________________________________________________
_____________________________________________________________________________________
____________________ _____________
CHAIRMAN DATE
Note: the Commission shall have sixty (60) days after the review of the final plat to approve or disapprove said plat per § 153.20(B).