Name of Subdivision                                                                
Location                                                           Zoning District                            
Owner                         Address                                   Tel.                       
Surveyor or Engineer                                                               
   Address                                            Tel.                         
Date submitted for preliminary plat approval                                      
Check List
               Copies submitted ten days prior to hearing.
               Notification of hearing to subdivider and adjoining property owners.
            Copies sent to City (or County) Engineer Health Commissioner for recommendations, if applicable.
             Copies of private deed restrictions, if any.
             Map (drawn to scale of not less than one inch equals 100  feet) contents:
                Name and location of subdivision
                Name of owner and surveyor
                Names of adjoining owners and/or subdivisions
                Date, north point and graphic scale
                Acreage of land to be subdivided
                Boundary lines of tract to be subdivided
                Proposed lot lines and lot numbers
                Contours at not more than five-foot intervals
             Location of platted streets and easements, within and adjacent to the tract, watercourses, existing sewers, water mains and culverts
                Profiles (one inch equals twenty feet) with grades indicated if required
                Cross-section (pavement width, sidewalks)
                Street names
             Plans and profile of proposed sanitary sewerage system
             Plans and profile of proposed water system
             Building set-back lines
             Public dedications and reservations of land, if any
Approved         (date)          to proceed to final plat.  Subject to the following modifications:                                                                                            
Variances granted:                                                                                    
Disapproved:          (date)        for the following reasons:                           
(Ord. 2005-34.  Passed 12-12-05.)