Name of Subdivision                                                                
Location                                         Zoning District                            
Owner                   Address                               Tel.                       
Surveyor or Engineer                                                               
   Address                                            Tel.                         
Date Submitted for preliminary plat approval                                      
Check List
             Submitted within one year of preliminary approval.
             Original and         prints submitted ten days prior to meeting.
             Certificate of ownership and dedication (Form 1).
             Certificate of accuracy (Form 2).
             One print transmitted to City Engineer and City Health Commissioner, if applicable.
             Certification of the approval of water and sewerage systems (Form 3 attached).
             Certification of the approval of streets and utilities (Form 4 attached).
             Private deed restrictions on or attached to plat.
             Map (drawn to scale of not less than one inch equals 100 feet) contents:
                Name and location of subdivision
                Date, true north point and graphic scale
                Reservations, easements or other nonresidential areas
                Location and description of all monuments
                True bearings and distances to nearest established control points or official monuments
                   Building set-back lines
                   Boundary lines of tract with accurate bearings and lengths
                   All dimensions to the nearest one-hundredth of a foot and all angles to the nearest minute
                Length of all arcs - radii, points of curvature and tangent bearings
                Lot lines, street lines and street names
                Lots numbered
                Names, locations of adjoining properties and streets
                Street profiles and cross-sections (if required)
             Required physical improvements have been made or bond posted in the amount of $                       
             Certificate of approval for recording (Form 5)
             Original drawing and one print of final plat returned to owner for recording
Approved for recording       (date)        Variances granted                     
Disapproved:          (date)        for the following reasons:                           
(Ord. 2005-34.  Passed 12-12-05.)