APPENDIX A: APPLICATION FOR LAND DIVISION

1.   Applicant

      Name_________________________________________   Telephone_____________________

      Address______________________________   City___________________   Zip_________

2.   Submissions Attached Are:

      3 copies of proof of ownership of parent parcel (recorded legal document of conveyance) including legal description

      3 copies of legal description * of proposed split(s) and remaining parent parcel

      3 copies of all required County review

      9 copies of current survey* of proposed split(s) and remaining parent parcel (only 3 copies are needed if making 2 splits)

      9 copies of this Application Form (only 3 copies are needed if making 2 splits)

* - Prepared by a Registered Land Surveyor or Licensed Civil Engineer. Survey must show existing structures, wetlands, lakes, streams, ponds, drives, public and private roads, easements, wells and septic fields on all parcels related to application.

3.   Application

      A.   Original Parent Parcel Size                            Acres

      B.   Size of Lot(s) to be split from parent parcel                      Acres

      C.   Remaining Parent Parcel Size                         Acres

      D.   Location of Proposed Land Division:

            Section #      Nearest Cross Road:_____________________

      E.   Parent Parcel ID#__________________________________________

Approval of a division is not a determination that the resulting parcels comply with other ordinances or regulations.

_______________________________________       Name Printed:___________________________
Applicant (owner’s) Signature

We hereby certify that the above was   Approved or   Denied for the reason

that:_________________________________________________________________________________

__________________________   _________________________   __________________________

Township Assessor         Township Clerk         Planning Commission

(Ord. 19, passed 12-10-1997)