YES NO
Submitted within 1 year of preliminary approval ____ ____
Original and fifteen (15) prints submitted 21 days prior to meeting ____ ____
FORM 1 Certificate of Ownership and Dedication ____ ____
FORM 2 Certificate of Accuracy ____ ____
FORM 3 Certificate of Recording ____ ____
FORM 4 Certificate of Availability of Water Supply ____ ____
FORM 5 Certificate of Approval of Streets ____ ____
FORM 8 Subsurface Sewage Disposal Note ____ ____
One print transmitted to Resident/County Engineer, or appropriate official,
and County Health Officer ____ ____
Private deed restrictions on or attached to plat ____ ____
Plat contents, per § 153.20(A), as follows:
A. Date; ____ ____
Label “Final Plat”; ____ ____
Graphic scale (not less than 1" = 100'); ____ ____
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 1/100th of an acre ____ ____
D. True bearings and distances to nearest established control points or official
monuments. ____ ____
E. Tract boundary lines; ____ ____
Right-of-way lines of streets, easements and other rights-of-way; ____ ____
Property fines of residential lots and other sides with accurate dimensions
to the nearest one hundredth of a foot; ____ ____
Bearings of deflection angles, radii, arcs and central angles of all curves with
dimensions to the nearest minute; ____ ____
Landscaping requirements shall be indicated to comply with design
standards. ____ ____
F. Proposed street layout including street names.
G. Lot numbers and addresses. ____ ____
H. Purpose for which sites, other than residential lots are dedicated or reserved. ____ ____
I. Minimum building setback lines. ____ ____
J. Location and description of monuments, including bench marks, existing
streams or other bodies of water, significant trees and tree stands,
sinkholes, etc. ____ ____
K. Names and location of adjoining subdivisions and streets;
Location of adjoining unplatted properties; ____ ____
Names and addresses of the owners of adjoining unplatted properties. ____ ____
L. Cross-sections, profiles and grades of streets, curbs, gutters showing the
locations of in-street utilities drawn to County specifications, and elevations; ____ ____
Road profiles and roadway design signed by a licensed engineer; ____ ____
Seal and signature of engineer. ____ ____
M. Protective covenants, if applicable. ____ ____