TOWN OF MIDDLETOWN PLANNING BOARD
APPLICATION FOR SUBDIVISION CERTIFICATE OF COMPLETENESS
Name of Project:
Stage of Review:
Date Filed:
Applicant's Name, Address and Telephone Number:
Developer's Name, Address and Telephone Number:
Assessor's Plate & Lot of Land Being Subdivided:
Type of Subdivision:
Subdivision Description:
IS APPLICATION A REVISION: Y OR N
IS APPLICATION A NEW SUBMISSION: Y OR N
ARE PREVIOUS PLANS TO BE WITHDRAWN: Y OR N
IF Y, DATE OF PLAN.)
Owner's Signature
(approval to subdivide)
Action Taken By Administrative Officer
Application Certified as Complete
Application is incomplete and returned. The following deficiencies exist:
Signature of Administrative Office (when certified complete)