Application #__________________
Plat Questionnaire
Name of Subdivision______________________________________________________________
Name of Owner_____________________________ Phone:______________________________
The following specific questions relating to this subdivision should be answered and this form included with the presentation of the plat.
Total number of acres in proposed subdivision________ Total number of lots anticipated________
Will new streets be created?________ How wide? ________Will any additional right-of-way be dedicated along existing streets? ________ How wide? ________
Name of Road ________ The subdivision will be served by (check one): Private Water Systems________ Public Water Supply________ Other ________(Specify) ___________________
The sanitary needs will be served by (check one): Septic Tanks________ Public Sanitary Sewerage System ________ Other________ (Specify)_____________________________________________
What type of storm drainage will be used? ________ Is any land other than streets to be dedicated for public use?________ Describe:_________________________________________________________
Will any natural drainage course be affected by the subdivision?________ Describe______________________________ Is the property subject to the one hundred year flood?__________ If yes, identify the flood zone: __________________________________________
State the base flood elevation:________________ What is the present use of the land?_____________
What is zoning classification?_____________________ Any proposed changes in zoning classification?___________________ Questionnaire prepared by_______________________________
(Ord. 18, 2001, passed 6-14-2001)