Appendix II

APPLICATION FOR
APPROVAL OF PRELIMINARY PLAT
CITY OF NEWARK
LICKING COUNTY, OHIO

Date:                

1.    Name of Applicant                      

   Address                         

   Telephone                         

2.    Name of Surveyor                      

   Address                         

   Telephone                         

3.    Engineer                         

   Address                         

   Telephone                         

4.    Name of Subdivision                      

5.    Present Zoning District                      

6.    School District                         

   Name of Schools Serving the Subdivision Area             

   High School                         

   Junior High or Middle School                   

   Elementary School                      

7.    Proposed Subdivision Will be Serviced by:

   Newark Water          Yes        No       

   Newark Sanitary Sewer       Yes        No       

   Ohio Power Co.          Yes        No       

   Licking Rural Electrification       Yes        No       

   Alltel Telephone          Yes        No       

   Cable Television - Company Name:                

8.    Proposed Subdivision:

      Total Acres                      

      Total Acres in Lots                   

      Total Acres in Roadway                

      Total Acres Other Than Lots or Roadways          

9.    Proposed Escrow Agent (Per Section 1222.03)          

10.    Proposed Deed Covenants or
   Restrictions Submitted          Yes        No       

11.    Six Sets of Drawings (prints)
   Submitted             Yes        No       

12.    Fee of $               Paid          Yes        No       

13.    Legal Description of Boundary of Proposed
   Subdivision Submitted          Yes        No       

                              
Applicant's Signature             Surveyor or Engineer's Signature

   Date Received:                      

   Date of Meeting to be Considered at:                

   Action by Planning Commission:                

                              
   Date                      Signature

(Ord. 93-62. Passed 10-3-94.)