APPENDIX C: APPLICATION FOR PRELIMINARY PLAT APPROVAL

Name of subdivision _______________________________________

Location _______________________________________

Name of subdivider _______________________________________

Address of subdivider _______________________________________

Phone No. where subdivider can be reached _______________________________________

Application is hereby made for approval of the preliminary plat. The following documents are made a part of this application:

   a.   Fourteen copies of the preliminary plat.

   b.   Fourteen copies of protective covenants and restrictions.

   c.   Preliminary plat fees. Refer to § 152.022 for applicable fees.

   d.   Certificate of zoning compliance from the effected city, if applicable.

   e.   Any other data the Plat Officer deems necessary.

Action by the Planning and Subdivision Committee should be sent to:

Name _______________________________________

Address _______________________________________

Respectfully submitted this _______ day of __________, 20___

Signed _______________________________________

Number of lots _________________________________.

County Department Review:

Public Health Officer                     Date reviewed _______________________________________

[phone]

Soil & Water Conservation District               Date reviewed _______________________________________

[phone]

County Clerk (verify taxes)                  Date reviewed _______________________________________

[phone]

County Engineer                     Date reviewed _______________________________________

[phone]

Emergency Telephone System (E911)            Date reviewed _______________________________________

[phone]

Plat Officer                         Date reviewed _______________________________________

[phone]

Planning and Subdivision Committee Action:

Recommend _____________         Recommend Conditionally _____________

Not recommend _____________

Comments: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date __________________________         _______________________________________

                        Chairman, Planning and Subdivision Committee

(Ord. 0-2005.4, passed 11-8-2005)