Town of Mills River
SUBDIVISION APPLICATION FORM
Date of Application Name Application Number
Other
Name:
Address:
City, , Zip:
Owner's Agent:
Telephone No:
PIN Deed Book/Page
Zoning District Fire District Watershed
Location of to be divided:
Type of : ( ) Residential ( ) Commercial ( ) Industrial Present Use
No. Created ______ Original Size New Size No.
System: ( ) Public ( ) Private ( ) Combination Public and Private
Water System: ( ) Individual ( ) Community ( ) Municipal
Sewer System: ( ) Individual ( ) Community ( ) Municipal
Fee: $ Paid Method
I certify that the information shown above is true and accurate and is in conformance with the Town of Mills River Ordinance.
APPLICANT ( OR AGENT) DATE
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TOWN USE ONLY
Received by: Date:
Fee Paid: Received by: Date:
Development Plan Approval / Conditions
Approval: Plat Recorded