APPENDIX B APPLICATION FOR PLAN APPROVAL

BOROUGH OF MARYSVILLE

200 Overcrest Road

Marysville, PA 17053

APPLICATION FOR PLAN APPROVAL

Property Owner Name:                                                                                                                                       

Property Owner Address:                                                                                                                                

Property Owner Phone Number:                                                                                                                    

Name of Applicant:                                                                                                                          

Address:                                                                                                                                                      

Phone Number:                                                                                                                                             

Name of Engineer/Surveyor:                                                                                                                          

Address:                                                                                                                                                      

Phone Number:                                                                                                                                             

Name of Developer:                                                                                                                                      

Address:                                                                                                                                                      

Phone Number:                                                                                                                                             

Title of Plan:                                                                                                                                                    

Plan Classification:              Subdivision              Redivision              Land Development              Other

(explain):                                                                                                                                                           

Type of Approval Request:                 Preliminary                 Final                 Minor

Previous Plan(s):                                               Recorder’s Office Reference:                                         

Total Tract Area:                                            Number of Lots/Units:                                                 

Zoning District:                                              Density Overall:                                                            

Water Supply:                                                 Linear Ft of New Street:                                               

Proposed Sewage Disposal:                                                                                                                             

Linear Ft of New Storm Sewer:                                                                                                                       

Linear Ft of New Sanitary Sewer:                                                                                                                  

Has a sewage module or DEP exemption been submitted:         Yes   Date Submitted:                      No

Improvements required:              None             Full Street             Partial Street             Sidewalks

         Curbing                 Sanitary Sewer                 Signs                 Storm Sewer                 Water Lines

          Other                                                                                                                                                        

The CHECKLIST FOR SUBDIVISION AND LAND DEVELOPMENT PLAN CONTENT is required to be submitted as part of this application. Checklist attached:                 yes

Are there any modifications of requirements?             yes             no

If so, list the specific section of the Ordinance from which relief is required and justification for the waiver. If additional space is needed, attach a separate narrative.

   1.    Modification of Requirement Requested & Justification:                                                                        

   Section of Ordinance                                                                         

   2.    Modification of Requirement Requested & Justification:                                                                        

   Section of Ordinance                                                                         

Have any variances been granted by the Zoning Hearing Board pertaining to this development?

                 If yes, attach a copy of the decision.

I hereby certify the plan submission represented by this application and checklist is complete and is prepared in conformance with all the applicable Marysville Borough Ordinances.

Signature                   Date

OFFICIAL USE ONLY:

Filing fee:   Preliminary:                  Amount:                       Date Paid:                       

      Final:                             Amount:                       Date Paid:                       

      Minor:                            Amount:                       Date Paid:                        

NOTE: Plans must be officially submitted to the Borough two (2) weeks prior to a Planning Commission meeting. Failure to submit complete and truthful data may result in refusal to process applications for plan approval.

Filing Date:                                                      90 days to begin:                                             

90 days end:                                       Last meeting prior:                                 90 day extension                 

(Ord. 614, 5/11/2015)